Medical Termination Of Pregnancy Research Articles

Étude du profil et du parcours des femmes en demande d’une Interruption Médicale de Grossesse maternelle au motif psychosocial au CHRU de Tours de 2017 à 2021

Objective: The law of 7 July 2011 adopts the concept of therapeutic abortion (Medical Termination of Pregnancy or MTP) for maternal reasons if the pregnancy poses a "serious threat" to the woman's health, allowing for the introduction of the concept of psycho-social distress.Materials and Methods: This was a retrospective monocentric study involving 33 women seeking IMG for psychosocial reasons between January 2017 and December 2021 at the University Hospital of Tours. The study resulted in 29 approvals and 25 MTP procedures performed.Results: Eighty-seven per cent of the requests were accepted. Over half of the women were under 25 years old and were primiparous. The procedures were performed at a mean gestational age of 22 weeks. 60% did not use contraception at the time of conception, and 36% did not use it after the MTP. About a third of the women experienced violence and had psychiatric histories. The majority of the women did not have stable economic resources. Fifty-six per cent of the MTP procedures involved feticide. There were 7 immediate complications with no subsequent consequences. The average time to completion was 16.5 days.Conclusion: This is a delicate and underexplored subject in literature. Although sporadic in France, these procedures have been practiced for many years. The diversity of opinions during multidisciplinary committees ensures the best objectivity.Requests for psychosocial IMG are rare, but responding to them is in accordance with the law. Analyzing the profile and journey of women has contributed to a better understanding of the complex situations that lead them to this decision.

Healthcare professionals and students’ knowledge on termination of pregnancy: A systematic review

Abstract Background Providing safe termination of pregnancy (TOP) according to each country’s legalisation is an important public health matter internationally. Healthcare professionals (HCPs) and healthcare students have key roles and need to be aware of legislation and clinical practice guidelines on TOP in their country to facilitate safe and effective care. The main aim of this systematic review was to investigate the level of knowledge on TOP legislation among HCPs and healthcare students. The second objective was to assess the knowledge of TOP methods, procedures and/or potential associated complications. Methods This is a systematic review of qualitative and quantitative peer-reviewed studies published in English or Portuguese until July 2020. Databases included in the search were EBSCO, PubMed, Embase and Scopus. The quality appraisal was done using the CASP Critical Appraisal tools. Results A total of 31 studies were included, published between 2002 and 2020 and from several regions around the globe. No studies were carried out in Europe or the United Kingdom. A total of 22 studies included healthcare professionals and nine studies included students. Overall, all the studies showed poor knowledge of TOP legislation and TOP methods, procedures and complications. Knowledge of special circumstances established in the law where TOP might be legal was also very limited. In studies focussing on medical (MA) and surgical (SA) TOP, knowledge of MA was lower than of SA. Studies reported that practitioners and students have limited training in TOP. Overall, education/training and experience with TOP seem to be the main factors associated with increased levels of knowledge. Similar results were found for student’s knowledge. Conclusions This study highlighted the importance of involving and promoting the participation of HCPs and students in the provision of TOP services. A clear need and desire for staff education and training on TOP was shown. Key messages • TOP training is limited and broadly excluded from medical and healthcare education globally. Students and staff have recognised this issue and the critical impact it has on TOP care provided. • Adequate knowledge and training in TOP ensures service sustainability and preparation of current and future healthcare practitioners to provide high-quality, respectful and compassionate care.

Oral vs Vaginal Misoprostol for Medical Termination of Pregnancy

Oral vs Vaginal Misoprostol for Medical Termination of Pregnancy

Effectiveness and Safety of Medical Abortion with Mifepristone and Sublingual Misoprostol up to 63 Days of Gestation

Background: The use of medical abortion increases among unplanned pregnant women. The primary objective of this study is to assess the outcomes of using a combination of Mifepristone followed by sublingual Misoprostol for the termination of pregnancy up to 63 gestational days. The secondary objectives were identifying significant factors that contribute to an increased rate of incomplete abortions resulting in surgical intervention and evaluating the safety of this medical procedure. Methods: This retrospective cohort study was conducted at Siriraj Hospital, a tertiary care center in Thailand, from July 2021 to December 2023. Women were given 200 mg of oral Mifepristone at the clinic, followed by self-administration of 800 μg of sublingual Misoprostol at home 36–48 hours later. A follow-up visit was scheduled approximately 14 days later to confirm the outcome of the procedure. Demographic and medical data were collected from medical records and subsequently analyzed. The primary outcome was defined as the success of the procedure, indicated by complete abortion without the need for surgical intervention. Secondary outcomes included assessing side effects and complications following medication administration, as well as identifying factors associated with an increased rate of incomplete abortions. Results: The final analysis included follow-up data from 205 women. Medical abortion was successful in 70.7% (145 out of 205) of cases, with no ongoing pregancies recorded. No serious side effects or complications were detected. Diarrhea and chills were the most commonly observed side effects. The study found that women with a history of previous abortions and those experiencing significantly heavier bleeding after the procedure were at a higher risk of incomplete abortion, requiring surgical aspiration. Conclusions: The regimen of oral Mifepristone followed by sublingual Misoprostol for medical termination of pregnancy is effective and safe through 63 days of gestation. A history of previous abortion and experiencing heavier bleeding after the procedure were identified as risk factors for incomplete abortion.

Perinatal Grief Counseling and Its Effect on Grief Levels in Women Who Underwent Pregnancy Termination: A Comparative Experimental Study.

This study was designed as a two-group pre-test post-test comparative experimental study to examine the effects of grief counseling on perinatal grief levels in women who underwent pregnancy termination before discharge from the clinic. This study was conducted with 70 women who underwent medical termination of pregnancy. The intervention group (n = 35) received perinatal grief care, while the control group (n = 35) received only routine hospital care. In this study, the Introductory Information Form, Perinatal Grief Scale, and evaluation form of the care received were completed. While the perinatal grief level of the intervention group decreased after the application of grief care, a significant difference between the groups was detected only in women with a history of medical termination according to obstetric characteristics (p < .05). The findings obtained from this study showed that perinatal grief care support decreased grief scores on perinatal grief instruments and their sub-dimensions in the intervention group.

Posterior reversible encephalopathy syndrome (PRES) on the second postpartum day: learning experience from a case report and literature review

BackgroundPosterior reversible encephalopathy syndrome (PRES) is an uncommon neurological disorder which is characterised by variable symptoms. The transient clinical condition may be underestimated and misdiagnosed as other conditions, especially, among pregnant women with severe preeclampsia, eclampsia, and HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome in the puerperium. We hereby contribute to the literature this rare complication and hightlight the appropriate management of PRES .Presentation caseA pregnant woman (gravida 3, parity 2) had a normal antenatal course. However, she was diagnosed with severe preeclampsia and HELLP syndrome at 29 weeks and 5 days of gestation. Therefore, she was indicated for a medical termination of pregnancy following a patient’s consent at our tertiary referral hospital. Severely, the patient developed rapidly with altered mental health in early puerperium. In result, PRES was diagnosed based on a brain magnetic resonance imaging (MRI) evidence with typical findings. After a strict multidisciplinary management, the clinical condition improved after 5 days of onset and recovered completely after a 4-month follow-up without any sequelae.ConclusionIn summary, despite its rarity, clinicians ought to be knowledgeable and raise an aware of PRES during pregnancy. Importantly, a brain imaging modalities should be taken into account among pregnant women with neurological symptoms subsequent to severe preeclampsia. In addition to early diagnosis, a timely appropriate treatment with multidisciplinary team is strongly indicated. Further studies with a large case series are required for this uncommon entity.

Medical termination of pregnancy: people’s expectations and experiences in the Netherlands

Purpose Annually, approximately 31,000 people experience a termination of pregnancy (TOP) in the Netherlands. In 2021, about one-third of them chose medical termination of pregnancy (MTOP). We explored experiences with MTOP and to what extent expectations, pain, and counselling in the clinic are associated with satisfaction with MTOP. Materials and methods A retrospective cross-sectional study was conducted using an online questionnaire. We included 138 respondents, ≥16 years, who chose MTOP (September 2020–March 2022). Results The majority of respondents experienced MTOP more positively than expected or as expected (67%). For 24%, the experience was more negative than expected. In the event of another TOP, half of these respondents would hesitate to choose or would not choose MTOP, mainly due to physical side effects. The majority of respondents (73%) would choose MTOP again. Their main motivation was self-determination during treatment. Respondents cited four key elements: pain, intensity of experience during and after treatment, blood loss, and duration. Correspondence between MTOP expectations and experiences was associated with satisfaction with MTOP, while pain and satisfaction with counselling were not. Conclusions The majority of respondents were satisfied with MTOP and would choose the treatment again. Non-correspondence between expectations and experiences negatively affected satisfaction with MTOP. This highlights the importance of managing expectations by providing accessible information about the variety in expectations and experiences to patients with a focus on key elements of the experience.

Prospective Analytical Study on Medical Termination of Pregnancy at Tertiary Care Centre in Western Rajasthan

Prospective Analytical Study on Medical Termination of Pregnancy at Tertiary Care Centre in Western Rajasthan

Fetal and Maternal Outcomes in a Cohort of Patients With Primary Sjogren's Syndrome: An Observational Study.

Background Pregnant women with primary Sjogren's syndrome (PSS) have a high incidence of maternal and fetal complications due to immunological variations caused by maternal antibodies (anti-Sjogren's-syndrome-related antigen A (SSA) and anti-anti-Sjogren's-syndrome-related antigen B (SSB) crossing the placenta from the 12th week of gestation, mediating the tissue damage. A multidisciplinary approach is required in the management of such patients. Data regarding the effects of PSS on pregnancy are deficient in the Indian context. Methods This was a retrospective observational study on the maternal and fetal outcomes of PSS on a cohort of pregnant women treated at our tertiary care center between 2011 and 2020. Patients who satisfied the criteria for PSS were included, and patients with other associated autoimmune disorders were excluded. Maternal age, number of miscarriages, prior obstetric history, and maternal and fetal complications were recorded and statistically analyzed. Results There were 16 pregnancies in 10 women with PSS (incidence: 1/1,000 pregnancies/year) in our study. The meangestational age of the mother at presentation was 31 ± 9.0 weeks. Oligohydramnios in five (11.8), intrauterine fetal demise (IUFD) in two (11.8), and first-trimester medical termination of pregnancy (MTP) in four (23.5) were noted. The weight of neonates was 2.3 ± 0.8 kg, and the mean duration of neonatal intensive care (NICU) stay was seven days. Fetal echo revealed congenital heart block (CHB), with six (50.0%) complete and one (8.3%) incomplete (p = 0.004). One baby needed a permanent pacemaker. Conclusion Maternal and fetal complications are high in our set of mothers with PSS. Early detection, regular follow-up, and a multidisciplinary approach may improve the outcome.

NT >99th centile and cystic hygroma: Which diagnosis, which management and outcome.

To evaluate the prevalence of chromosomal anomalies in fetuses affected by increased nuchal translucency(iNT >99Th centile), cystic hygroma (CH) and cases progressing to fetal hydrops (NIHF) in order to correlate this result to prognosis and perinatal fetal outcomes, improving patient's counseling. From January 2020 to December 2023, first trimester screening according to FMF criteria were performed in "Maternal fetal medicine Unit" of Foggia's hospital. We studied and collected clinical data of fetuses affected by nuchal translucency >99th centile (iNT), CH and cases progressing to Fetal Hydrops (non-immune fetal hydrop, NIFH). In these selected cases, we evaluated fetal Karyotype to demonstrate the presence of chromosomal abnormalities, associated to fetal structural anomalies and different pregnancy outcome. We have evaluated 45 cases of iNT, CH, and NIFH, identified by ultrasound during first trimester screening. Of these 45 pregnant women, four were lost to follow-up. Of the 41 pregnancies, 20 cases (48.8%) delivered at our division with newborns discharged in good health. Of the 21 patients (51.2%) who miscarried, only two miscarried spontaneously; the other 19 decided on a medical termination of pregnancy (MTP). The 19 patients who decided for MTP showed genetic abnormalities and/or malformation. The 20 cases of fetuses discharged as healthy newborns were enrolled with the following diagnoses: 5 had a diagnosis of CH (20% of cases), 1 case of NIFH (5% of cases), and 14 of iNT (75% of cases). All these fetuses had a normal karyotype and no major malformations. Isolated CH diagnosis is more frequent than described in Literature (5 cases out of 12: 41.7%) and their prognosis are better than previously described, with the same outcomes of fetuses with iNT without associated anomalies. The possibility of early diagnosis of chromosomal anomalies, associated malformations or the evolution into hydrops is essential for a complete consultation.

Medical termination of pregnancy with digoxin in a patient affected by severe congenital toxoplasmosis.

SynopsisIntrafetal digoxin is a safer and effective alternative to perform medical termination of pregnancy over intracardiac potassium chloride in cases of massive placental inflammation, such as congenital infections.

P-310 Impact of adenomyosis on the live birth rate during management by in vitro fertilization : a French study

Abstract Study question Evaluate the impact of adenomyosis on the likelihood of live birth after a fresh embryo transfer. Summary answer Adenomyosis reduces the live-birth rate. The location of adenomyosis and the type of protocol appears to have no impact on the live birth rates. What is known already The prevalence of adenomyosis varies between 7 and 27%, and affects 25% of infertile women. Its impact on fertility remains debated. According to some studies, it leads to a lower pregnancy rate, a doubling of the spontaneous miscarriage rate and a lower live birth rate as compared to non-adenomyosis women. However according to some authors adenomyosis does not reduce the live birth rate. Similarly, the impact of the location of adenomyosis remains debated. On the impact of the stimulation protocol, several studies have shown that the use of GnRH agonist improves the live birth rate in patients with adenomyosis. Study design, size, duration This is a retrospective, descriptive and observational study, managed at the fertility department of Dijon University Hospital between January 2015 and March 2020. Systematically, the women infertility cause was assessed. We compared the group of patients with adenomyosis (i.e. symptomatic adenomyosis completed with a 3D ultrasound within a maximum of 1 year prior to management) with controls (i.e. patients treated for another cause of infertility). Ultrasound was performed by the same two experienced operators. Participants/materials, setting, methods We included 340 patients aged 18-41 years. Data concerning live births and type of stimulation protocol were collected from the patient’s electronic medical and therapeutic records. MUSA classification was used to determine whether the adenomyosis was localized or diffuse. The primary endpoint of this study was the live-birth rate (LBR) after fresh embryo transfer. The implantation and miscarriage rates were also compared. Main results and the role of chance We included 92 patients in adenomyosis group, and 248 patients in control group. Baseline characteristics of patients including women age, BMI and smoking habits were comparable in both groups. Moreover, no difference was found on the mean number of mature oocytes and embryos between the two groups. LBR after fresh embryo transfer was significantly lower in the adenomyosis group than in the control (34.8 % versus 41.5%, respectively, p = 0,02). There was no significant difference in implantation rate (35.7% versus 37,4%, p = 0.76). Early miscarriage rate (&amp;lt;12 weeks of amenorrhea) was higher in the control group than the adenomyosis group (15.3 versus 7.5, p = 0.012). Concerning late miscarriage (&amp;gt;12 weeks of amenorrhea), we observed 3 medical termination of pregnancy (all for fetal malformation) and 1 miscarriage (10%) in the adenomyosis group and 1 miscarriage (0.81%) in the control group (p = 0.02). Subgroup analyses showed no decrease in LBR according to adenomyosis location (32.7% versus 37.2% in the diffuse and localized groups, respectively, p = 0.46). Limitations, reasons for caution Even though our cohort is a good reflection of the all-French population of Burgundy since all patients are treated at the fertility center of Dijon. Despite its retrospective nature and the small number of included adenomyosis-patients, the ultrasound scans were performed by two experienced operators that reduced inter-observer variability. Wider implications of the findings It would be useful to carry out a prospective study including more patients to better assess the impact of location on implantation. It would also be interesting to evaluate neonatal and obstetrical complications, especially the late miscarriage issue requiring further investigation. Trial registration number non-clinical trials

Unraveling the mystery of a rare neural tube defect: Antenatal sonographic diagnosis with a brief literature review

We present the case of a 42-year-old woman who underwent a level II ultrasound revealing rare and severe fetal anomalies consistent with craniorachischisis. These included absent calvarial bones, exposed cerebral tissue suggestive of acrania-exencephaly, and a spinal defect with diverging laminae and exposed spinal canal indicative of rachischisis. After thorough parental counseling, the mother opted for medical termination of pregnancy. Postnatal confirmation of prenatal sonographic findings underscored the accuracy of the antenatal sonographic diagnosis.

Fetal deaths from birth defects in Hunan Province, China, 2016–2020

To describe the fetal death rate of birth defects (including a broad range of specific defects) and to explore the relationship between fetal deaths from birth defects and a broad range of demographic characteristics. Data was derived from the birth defects surveillance system in Hunan Province, China, 2016–2020. Fetal death refers to the intrauterine death of a fetus at any time during the pregnancy, including medical termination of pregnancy. Fetal death rate is the number of fetal deaths per 100 births (including live births and fetal deaths) in a specified group (unit: %). The fetal death rate of birth defects with 95% confidence intervals (CI) was calculated by the log-binomial method. Crude odds ratios (ORs) were calculated to examine the relationship between each demographic characteristic and fetal deaths from birth defects. This study included 847,755 births, and 23,420 birth defects were identified. A total of 11,955 fetal deaths from birth defects were identified, with a fetal death rate of 51.05% (95% CI 50.13–51.96). 15.78% (1887 cases) of fetal deaths from birth defects were at a gestational age of < 20 weeks, 59.05% (7059 cases) were at a gestational age of 20–27 weeks, and 25.17% (3009 cases) were at a gestational age of ≥ 28 weeks. Fetal death rate of birth defects was higher in females than in males (OR = 1.25, 95% CI 1.18–1.32), in rural than in urban areas (OR = 1.43, 95% CI 1.36–1.50), in maternal age 20–24 years (OR = 1.35, 95% CI 1.25–1.47), and ≥ 35 years (OR = 1.19, 95% CI 1.11–1.29) compared to maternal age of 25–29 years, in diagnosed by chromosomal analysis than ultrasound (OR = 6.24, 95% CI 5.15–7.55), and lower in multiple births than in singletons (OR = 0.41, 95% CI 0.36–0.47). The fetal death rate of birth defects increased with the number of previous pregnancies (χ2trend = 49.28, P < 0.01), and decreased with the number of previous deliveries (χ2trend = 4318.91, P < 0.01). Many fetal deaths were associated with birth defects. We found several demographic characteristics associated with fetal deaths from birth defects, which may be related to the severity of the birth defects, economic and medical conditions, and parental attitudes toward birth defects.

The Incongruity Between the Medical Termination of Pregnancy in India and United States: A Comparative Study

Abortion is a controversial right in developing countries such as India. Certain nations place limitations on human rights that are declared under the pretext of the "mother's right to health," while others restrict The act is carried out to protect the embryo's right to life. In the struggle to maintain the balance between the rights of the fetus and the rights of pregnant women, judicial intervention is crucial. Just as in India, the personhood of the fetus and abortion are incompatible with women's reproductive autonomy. Despite this, the Indian judiciary is working to change laws to make them more accepting of women who choose to have abortions and more in line with the circumstances of extraordinary instances. The intention is to provide a more comprehensive understanding of abortion laws and policy in India and the United States. This subject has been studied by researchers with an emphasis on women's reproductive rights. It will concentrate on the abortion-related laws made in the USA and India. This research will compare the conditions of women in emerging nations to those of developed nations, specifically the United States. With the aid of existing legislation and knowledge of pertinent modifications made to it, scholars will draw conclusions on women's reproductive rights.

Misoprostol-induced seizures following self-abortion: a rare, but repeated occurrence

Misoprostol is a synthetic prostaglandin E1 (PGE) analogue used for medical termination of pregnancy, managing miscarriage, inducing labour, cervical ripening, and treating postpartum haemorrhage. Generally, it is safe and well-tolerated, with dose-dependent adverse effects such as nausea, vomiting, diarrhoea, abdominal pain, fever, and headache that usually resolve within a few days. However, seizures are a rare complication, occurring primarily in patients with a history of epilepsy or a predisposition to seizures and is associated with high doses and rapid administration. This case report highlights the repercussions of a misoprostol overdose used for pregnancy termination, leading to seizures induced by hyperthermia. The first patient required temporary invasive ventilation and resuscitation but recovered, whereas the second patient receiving a lower dose, exhibited milder symptoms. Both patients received psychosocial counselling prior to discharge.

AN ANALYSIS ON TRENDS AND MAJOR FACTORS REGARDING ABORTION AND ACCESSIBILITY

The abortion or the termination of a pregnancy by chemical,surgical or other means became legal in 1971.Any women seeking an bortion would be entitled be have one under the medical termination of pregnancy (MTP) Act, was adopted that year as along as the grounds she claims are legal.The act modifies the 1971 enactment by increasing the number of weeks a women can terminate her pregnancy and establishing specific conditions in which a pregnancy can be terminated at any time.while the amendme has increased abortion access to some extent it fails to address one fundamental flaw in the medical termination of pregnancy act of 1971,that a woman does not have the right to Terminate a pregnancy but may be allowed to so only in certain specified circumstances,and only if a medical professional determines that does circumstances are met.The main objective of this research is to whether the sexual activity among the youth is a grave cause for concern and immoral activity of abortion. Key words: Termination,pregnancy,MTP ACT,specific conditions

Prenatally Diagnosed Congenital High Airway Obstruction Syndrome: Perinatal Management and Outcome—A Single Tertiary Care Center Experience

AbstractTo report our experience with the management of prenatally diagnosed cases of congenital high airway obstruction syndrome (CHAOS) and the postnatal outcome of those who underwent an ex utero intrapartum treatment (EXIT) procedure. This is a single center, retrospective observational study of prenatally diagnosed CHAOS cases using two-dimensional ultrasound from December 2017 to December 2022 in a tertiary care facility. Of the total nine fetuses prenatally diagnosed with CHAOS, three (33.3%) were associated with multiple congenital anomalies, seven out of nine (77.8%) developed ascites, and one had fetal hydrops. Five (55.6%) underwent medical termination of pregnancy and two were lost to follow-up (22.2%). The remaining two continued pregnancy and required EXIT tracheostomy at the time of delivery (22.2%). Microarray was performed in both which was normal. Postnatally, both infants are tracheostomy dependent with one requiring frequent ventilator support. CHAOS even when isolated generally has poor prognosis without intervention. Performing an EXIT procedure at birth can significantly improve postnatal survival by minimizing hypoxic damage. However, the long-term medical and surgical challenges for survivors remain numerous especially speech disorders, even after lifesaving fetal intervention and surgical correction. Therefore, an accurate prenatal diagnosis is necessary to give the couple an option of continuing pregnancy after realistic counseling regarding the prognosis and postnatal outcome.

#2289 Pregnancy outcomes in patients with congenital abnormality of the urinary tract: experience of a tertiary Portuguese center

Abstract Background and Aims Congenital abnormalities of the urinary tract (CAKUT) represent a broad range of disorders that occur due to abnormal kidney development. Maternal, obstetric, and perinatal outcome in pregnant woman with CAKUT have not been extensively evaluated, although small series report an increased incidence of urinary tract infections (UTI) and obstructive uropathy. Method Retrospective analysis of maternal, obstetric, and perinatal outcomes in pregnant patients with CAKUT (including genetic cystic kidney disease) that were surveilled in our tertiary center by a nephro-obstetric team between 2011 and June 2023. Information was obtained from medical records. Results We evaluated 47 gestations in 41 patients, with mean age of 31 ± 5 years [17-40], 89% were Caucasian, 11% black; 40% were nulliparous, 36% had hypertension (HT) and 42% a previous history of UTI. Regarding CAKUT specificity, 17/41 patients had genetic cystic diseases, 10/41 ureteropelvic junction obstruction (UPJ), 4/41 duplicate collecting system, 5/41 vesicourethral reflux, 2/41 ectopic kidney, 3/41 renal hypoplasia. Genetic testing was done before, during or after pregnancy in 2/4/4 patients, respectively. Teratogenic therapy exposure occurred in 25% of gestations. Most patients were CKD stage 1 (33/41), with 2/4/1/1 with patients in CKD stage 2/3/4/5, respectively. Mean baseline SCr was 0.99 ± 0.8 mg/dL [0.4-4.6] and mean proteinuria was 194 ± 357 mg/g [22-1500]. Renal function (RF) deterioration occurred in 9/47 (19%) women due to pre-eclampsia (PE), pregnancy hyperfiltration (PH) and hydronephrosis in 3/3/3 patients, respectively. Urologic intervention was needed in 2 patients due to hydronephrosis, and one of the patients required transient dialysis. All patients fully recovered RF except for the 1 CKD stage 3 patients that had partial RF recovery. De novo and worsening proteinuria occurred in 7/47 gestations due to PE (3/7) and PH (4/7). De novo or aggravation of HTN occurred in 25% gestations, UTI in 19% and PE in 6% gestations. Regarding fetal outcomes, mean duration of gestation was 38 ± 2 weeks [32-41] and mean birth weight 2910 ± 634 g [1360-4600]. There was 1 miscarriage and 1 medical termination of pregnancy at 17 weeks (neural tube defect). Cesarean was performed in (8/47, 17%) gestations and 10/47 (17%) newborns were admitted to the neonatal care unit (NICU) mainly due to prematurity, sepsis and feeding intolerance. Conclusion Our cohort of CAKUT patients was very heterogenous and only 19.5% had CKD stage 2-5. Still, we found a significant incidence of maternal, obstetric, and perinatal complications, namely HT UTI, PE, and the need for NICU. UPJ obstruction can evolve with RF deterioration and the need for intervention during pregnancy. This study underlines the importance of the management of these patients by a multidisciplinary team.

#2172 Maternal, obstetric and perinatal outcomes in pregnant women with lupus nephritis: experience of a tertiary center

Abstract Background and Aims Pregnant patients with systemic lupus erythematosus (SLE) and lupus nephritis (LN) are at particular risk for unfavourable maternal, obstetric and perinatal outcomes, especially if the disease is active. Thus, it is of paramount importance that LN patients have preconceptional counseling in order to optimize care and define the best moment to conceive. Method Observational retrospective study based on the review of medical records of pregnant women with lupus nephritis surveilled at our multidisciplinary maternal-fetal clinic from 2011 to 2023. Results We evaluated 26 gestations in 24 patients. Mean age was 30,8 years (19-40), 21 women were Caucasian, 2 black African, 1 Asian; 10/24 were nulliparous and 6/24 had chronic hypertension (HTUN). Mean baseline SCr was 0,79 mg/dl (0.5-3.5), baseline proteinuria &amp;gt; 1 g/day or &amp;lt;0,5 g/day was present in 3/26 and 22/26 gestations, respectively. Chronic kidney disease (CKD) stage 2, 3 and 5 was present in 1, 2 and 1 gestation respectively; 5/24 patients were APL positive; positive dsDNA and complement consumption at baseline were present in 4/26 and 12/26 gestations, with most patients previously having class IV LN (15/23). Active lupus nephritis during pregnancy occurred in 3 patients: 2 were submitted to medical termination of pregnancy (due to severe pulmonary HTN and renal function deterioration) and 1 was successfully treated with tacrolimus, azathioprine and prednisolone from week 28, and biopsied postpartum. Exposure to teratogenic therapy during the 1st trimester occurred in 3/26 gestations with a mean exposure of 8,5 weeks. Worsening kidney function occurred in 3/24 patients due to PE (1/26 CKD stage 3)/LN (1/26 stage CKD3)/pregnancy hyperfiltration (1/26 CKD stage CKD5), with partial and full renal recovery in 2 CKD stage 3 patients and dialysis initiation in the CKD stage 5 patient at 19 weeks (urea levels &amp;gt; 100 mg/dL). De novo proteinuria occurred in 3/24 patients (due to LN) and worsening proteinuria in 6/24 patients (PE 2/6; pregnancy hyperfiltration 4/6). De novo or worsening HTN occurred in 3/26 gestations. Immunosuppression during pregnancy consisted on azathioprine, prednisolone and hydroxychloroquine. SLE Flares occurred in 7/26 (27%) patients, with minor relapses in 4/6 gestations (hepatic, skin and articular involvement) and major renal flares in 3/6 gestations. All renal relapses occurred in patients with no preconception counseling nor immunosuppressive therapy. PE occurred in 2/26 (7,6%) gestations. Abortion occurred in 6/26 pregnancies (3 spontaneous abortions, 2MTP, 1 voluntary interruption). Cesarean (C) rate was 34,6%. Mean gestation age at delivery was 37±3 (28-40) weeks. Mean birth weight was 2789±859 mg (800-4175), 4 newborns were low birth weight (&amp;lt;2500 g). Apgar scores at 5/10 minutes were 10/10, respectively. Neonatal intensive care (NICU) was needed in 5 newborns. Conclusion In our series of SLE patients with LN, worsening kidney function only occurred in patients with advanced CDK, and renal flares in patients without preconceptional counseling nor immunosuppressive therapy, which underlines the importance of careful pregnancy planning. One patient with proliferative LN was successfully treated with tacrolimus associated to azathioprine and prednisolone during pregnancy, being a valuable therapeutic option in these situations. Although SLE patients with LN can have safe pregnancies, we still found an increased incidence of maternal, obstetric and perinatal complications, namely HTN, PE, C, low birth weight and the need of NICU.