An observational prospective study of clinical profile and obstetrical and neonatal outcome of Pregnancy Related Acute Renal Failure occurred in a tertiary care hospital of Rajasthan

Abstract

Objective: To study the clinical profile and obstetricaland neonatal outcome of cases of pregnancy related acute failure (PRARF)failure occurred in a tertiary care hospital of Rajasthan Materials and Methods:All patients with PRARF admitted in S.M.S medical college since July 2009 to July 2010 were analyzed Result:Total no of Acute Renal Failure cases was 60. Age range of cases was 19 years to 40 years, while mean age was 26.2±.56 yrs. In total cases, 61.7% were multipara and remaining 38.3% were primi. In 80% cases deliveries were conducted in hospital remaining 20 % delivered at home. 85%patients have attended antenatal clinic. PRARF was seen in 58.3% cases during post-partum period. During the 3 rd trimesternumber of cases was 12(20%) followed by 13.3% and 8.3% in 2 nd and 1 st trimester. Total number of women with PRARF was 60, whereas, the total number of patients with acute renal failure (ARF) was 1557. The frequency of PRARF was 3.85% of all ARFPallor was present in 93.3% women. Bleeding per vaginum was complained by 46.7% women with acute renal failure. Edema was present in 41.7% cases. Sign of icterus was present in 21.7% cases. Various abnormal laboratory finding were noted among the pregnancy related acute renal failure cases, Anemia were present in 68.3% cases. Electrolyte disbalance were present among 38 (63.3%) of cases. Out of these hyponatremia was the commonest condition, in about 50% cases it was find out. Abnormal liver function test was present in 45% cases. Puerperal sepsis (31.7%) was the most common cause of pregnancy related acute renal failure followed by anti-partumhemorrhage (25%). PET/ Eclampsia were underlying cause among 16.7% cases. Post abortion sepsis was the cause of in 5% cases of pregnancy related acute renal failure. In half of the cases delivery were normal, in 23.4% cases LSCS were performed. D&E done in 15% cases while 5% pregnancy terminated as Abortion.Anuria was present in 21.7 % cases, while 65% suffered from oligouria. Mean creatinine level was 4.5±0.62. Mean duration of oligouria 18.2 ±12 days. Non oligouric condition was present in 8(13.3%) cases. Dialysis was needed in 36(60%) cases, hemodialysis was given to 26 cases, while 6 (10%) were on Peritoneal dialysis and 4(7.5%) on venovenous dialysis.19 cases were completely recovered, 20 cases partially, and remaining 21 died. In 12 cases operative procedure was done, in 8 cases evacuation and in 4 cases hysterectomy was done. As outcome of fetal survival out of total pregnancy 20 died and 40 survived. IUD was most common cause (60%) among fetal death.Conclusions:PRARF remains acritical situation in developing countries where sepsis is the most frequent etiology, followedby anti-partum hemorrhage (25%). PET/ Eclampsia were underlying cause among 16.7% cases. Post abortion sepsis was the cause of in 5% cases of pregnancy related acute renal failure. Prevention is the best and least expensive solution