Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Ren Fail. 2010 Jan;32(3):309-13. doi: 10.3109/08860221003606265.
The data directly evaluating acute renal failure (ARF) in third trimester of pregnancy from Indian subcontinent are scanty. This study analyzes the clinical spectrum of ARF with respect to total birth in third trimester of pregnancy.
All pregnant women after the 28th week of pregnancy or in early postpartum period (up to 7 days) admitted to our hospital between August 2006 and August 2008 were screened for clinical evidence of ARF. Pregnant women with clinical diagnosis of ARF in third trimester were included in this study.
Of the 4758 pregnant women in third trimester, ARF developed in 85 cases (1 in 56 births). Preeclampsia, puerperal sepsis, and intrauterine death were responsible for ARF in 35.29, 24.7, and 16.67% of cases, respectively. Postpartum hemorrhage and antepartum hemorrhage were the causes of ARF in 10.59 and 8.29% of patients, respectively. Acute fatty liver of pregnancy was noted in one patient. Complicated preeclampsia (hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, eclampsia, and uterine hemorrhage) was associated and higher incidence of ARF. Live birth occurred in 61.2% of patients with vaginal delivery in 70% cases. Renal cortical necrosis was diagnosed in two cases. Overall, mortality was 20%. The puerperal sepsis contributed 41% of total death.
ARF complicated 1.78% of total delivery in third trimester of pregnancy. Preeclampsia was the most common cause of ARF followed by puerperal sepsis. In contrast to the developed countries, incidence of ARF is still very high in late pregnancy in the developing countries. Overall mortality was 20% with highest (33%) mortality in puerperal sepsis group.
来自印度次大陆的关于妊娠晚期急性肾衰竭（ARF）的直接数据很少。本研究分析了与妊娠晚期总分娩有关的 ARF 的临床谱。
2006 年 8 月至 2008 年 8 月期间，我院收治的所有妊娠 28 周后或产后早期（最多 7 天）的孕妇均进行了 ARF 的临床证据筛查。将妊娠晚期临床诊断为 ARF 的孕妇纳入本研究。
在 4758 名妊娠晚期孕妇中，有 85 例（每 56 例分娩 1 例）发生 ARF。子痫前期、产褥期败血症和宫内胎儿死亡分别占 ARF 的 35.29%、24.70%和 16.67%。产后出血和产前出血分别是 10.59%和 8.29%患者 ARF 的原因。1 例患者出现急性妊娠脂肪肝。复杂的子痫前期（溶血、肝酶升高和血小板计数降低（HELLP）综合征、子痫和子宫出血）与 ARF 发生率较高有关。61.2%的患者经阴道分娩存活，70%的患者经阴道分娩。诊断为皮质坏死 2 例。总体而言，死亡率为 20%。产褥期败血症导致 41%的总死亡。
ARF 占妊娠晚期总分娩的 1.78%。子痫前期是 ARF 的最常见原因，其次是产褥期败血症。与发达国家相比，发展中国家妊娠晚期 ARF 的发病率仍然很高。总死亡率为 20%，产褥期败血症组死亡率最高（33%）。
