Multiple pregnancies in women after renal transplantation. Case report that rises a management dilemma.
OBJECTIVE
To report the pregnancy outcome in women with multiple pregnancies after renal transplantation.


METHODS
We report two cases of multiple pregnancies (triplets and twins) in renal allograft recipients and evaluate the pregnancy courses and maternal and fetal outcome of these patients.


RESULTS
After fetal reduction from triplet to twin pregnancy the first patient delivered healthy twin babies at 36 weeks gestation. Six months after delivery the woman is well with no signs of renal function impairment. Although the second patient did not meet the optimal criteria for consideration of pregnancy in renal transplant recipients, she delivered normal twin babies at 33 weeks' gestation. Maternal complications during pregnancy included preeclampsia, mild deterioration of renal function tests, and secondary complications due to drug therapy that was resolved after delivery. No graft rejection episodes were noted in either case during pregnancy.


CONCLUSIONS
Multifetal gestation in renal allograft recipients represents a high-risk pregnancy that should be managed at a tertiary care institution. The overall outcome in properly consulted patients can be considered favorable. Based on our limited experience with two cases, we suggest reduction of triplets to a twin pregnancy which is consistent with the current literature data.
Department of Obstetrics and Gynecology, Soroka Medical Center, Faculty of Health Sciences Ben-Gurion University of the Negev, Beer-Sheva, Israel.
B
B
Furman
A
A
Wiznitzer
R
R
Hackmon
J
J
Gohar
M
M
Mazor
D000328:Adult; D001034:Apgar Score; D002585:Cesarean Section; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D005317:Fetal Growth Retardation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007231:Infant, Newborn; D016030:Kidney Transplantation / Q000502:physiology*; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal; D018566:Pregnancy, High-Risk / Q000502:physiology*; D011272:Pregnancy, Multiple / Q000502:physiology*; D014310:Triplets; D014427:Twins
D007166:Immunosuppressive Agents