#4109 THE IMPACT OF IMPLEMENTING AN INNOVATIVE OBSTETRIC NEPHROLOGY SERVICE ON MATERNAL AND FETAL OUTCOMES IN WOMEN AT RISK OF PR-AKI

Abstract

Abstract Background and Aims Pregnancy Related Acute kidney injury (PR-AKI) is a global health problem with substantial maternal and fetal morbidity and mortality. Late referral, and late diagnosis of women with risks of PR-AKI represent the major barriers for curtailment of this ugly trend, particularly in the developing world. Our past experience per se revealed striking maternal and fetal mortality of women with PR-AKI. Great strides are strongly needed to save maternal and fetal lives. This study assessed the impact of implementing an innovative obstetric nephrology service (ONS) and healthcare program on maternal and fetal outcomes in women at risk of PR-AKI. Method An innovative interdisciplinary obstetric nephrology clinic was established in 2020 to improve the quality of care for pregnant women at risk of PR-AKI. The service was staffed by both nephrologists and obstetricians. Women who presented to the clinic were stratified into low, moderate, and high-risk groups. A risk stratification-based care program was adopted. Very high-risk women were admitted to the maternal care unit. The study compared the outcomes of ONS-treated women who completed their follow up (n = 43) versus two groups of conventionally treated women (n = 40) and women presented before service (n = 40). Results Although they had greater pre-existing risks, ONS-treated women had no reported maternal or fetal mortality compared to women in the conventionally treated group (11.8% and 51.5% respectively), and to women presented before service (22.5% and 45% respectively). Progression to end-stage renal disease was significantly less in ONS-treated women compared to both conventionally treated and those treated before service (3% versus 13.2% and 37.5% respectively). Conclusion Easily feasible Obstetric nephrology service implementation and adoption of early referral program and diagnosis policies were associated with better maternal and fetal survival as well as better renal outcomes. Provision of parallel services is strongly recommended to decrease the magnitude of PR-AKI.