Assessment of risk factors and pregnancy outcomes in women with thrombotic microangiopathy in Ain Shams University Maternity Hospital over a 5-year period

Abstract

Thrombotic microangiopathy in pregnancy can lead to maternal and fetal life-threatening adverse events. Objective. To study the demographic characteristics (age, parity), risk factors, treatment modalities, and pregnancy outcomes in women with thrombotic microangiopathy in Ain Shams University Maternity Hospital over a 5-year period. Patients and methods. This study was retrospectively conducted at Ain Shams University Maternity Hospital and included 419 patients; the study population were pregnant women admitted to the hospital from January 2014 to December 2018, with pregnancy-associated thrombotic microangiopathy. The study was performed through revising the medical records in the archive and the ICU and contacting the patients to assess demographic data, risk factors, presentation of the patient, type of the syndrome, and the maternal and fetal outcome. Results. HELLP syndrome was the most common pregnancy complication. In most of cases, women delivered by cesarean section (72.1%). Complications included chronic hypertension (CHTN), acute kidney injury (AKI), chronic kidney injury (CKI). Maternal mortality was significantly more frequent in hemolytic uremic syndrome (HUS). Maternal mortality was 8.8 %, and neonatal mortality was 26.7%. Most of women were admitted to the ICU (87.1%). Conclusion. Thrombotic microangiopathy in pregnancy continues to pose a large challenge to obstetricians, immunologists, and nephrologists due to potential risks and complications. Pregnancy outcome is more optimistic when termination of pregnancy occurs early in the disease with the possible use of corticosteroids with or without plasma exchange transfusion under the control of a multidisciplinary approach team. Key words: risk factors, outcome, pregnant women, thrombotic microangiopathy