Ozlü Tülay, Dönmez Melahat Emine, Dağıstan Emine, Tekçe Hikmet
Department of Obstetrics and Gynecology, Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey.
Department of Radiology, Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey.
J Turk Ger Gynecol Assoc. 2014 Jun 1;15(2):125-7. doi: 10.5152/jtgga.2014.45389. eCollection 2014.
Here, we aimed to present a case of safe vaginal delivery in a renal transplant recipient and to mention the possible additional risks of caesarean section in such cases. A 40 year-old patient (G4P3), who had undergone renal transplantation 5 years ago, was admitted to our clinic at 39(2/7) weeks of pregnancy. The transplanted kidney at right iliac fossa was sonographically normal except for grade 1 hydronephrosis; the proximity of vascular anastomoses between the transplanted kidney and iliac vessels to the lower segment of the uterus was remarkable. There was no contraindication for vaginal delivery and it was believed that there would be a possible risk of injury to the transplanted kidney with caesarean delivery. The patient delivered a healthy baby weighing 3540 grams. There is a risk of injury to the renovascular and ureter anastomoses in renal transplant recipients during caesarean delivery. Normal vaginal delivery without abdominal compression is the safest method of delivery in these patients. If a situation that can necessitate internal iliac artery ligation or caesarean hysterectomy such as placenta accreata is expected, surgery should be performed in a centre where the renal transplant surgeon can oversee the surgery.
在此，我们旨在介绍一例肾移植受者安全阴道分娩的病例，并提及此类病例中剖宫产可能存在的额外风险。一名40岁患者（孕4产3），5年前接受了肾移植，在妊娠39（2/7）周时入住我院。右侧髂窝处的移植肾超声检查除1级肾积水外无异常；移植肾与髂血管之间的血管吻合口靠近子宫下段，情况显著。阴道分娩无禁忌证，且认为剖宫产分娩可能有损伤移植肾的风险。该患者分娩出一名体重3540克的健康婴儿。剖宫产分娩时，肾移植受者存在肾血管和输尿管吻合口损伤的风险。对于这些患者，不进行腹部按压的正常阴道分娩是最安全的分娩方式。如果预计会出现诸如胎盘植入等需要结扎髂内动脉或行剖宫产子宫切除术的情况，手术应在肾移植外科医生能够监督手术的中心进行。
