title: Maternal hemodynamics and pregnancy outcome in women with prior orthotopic liver transplantation.
abstract: The aim of this study is to evaluate the hemodynamics and pregnancy outcome of women with prior orthotopic liver transplantation. Hemodynamic measurements by Doppler technique were performed on pregnant subjects with prior orthotopic liver transplantation. Maternal characteristics, renal function, pregnancy complications, delivery indications, delivery mode, and neonatal outcomes were evaluated. Six pregnancies occurred in 5 women after orthotopic liver transplantation at the University of Washington Medical Center (Seattle, WA) between 1991 and 1999. Four of the 6 pregnancies were complicated by chronic hypertension, fetal growth restriction, and preterm delivery. Two pregnancies had worsening hypertension characterized by vasoconstriction in the second trimester despite antihypertensive therapy. These 2 subjects were administered cyclosporine for maintenance immunosuppression and had greater mean arterial pressures preconception and in the first trimester than the other subjects. One of these pregnancies resulted in fetal demise at 25 weeks' gestation. The other subject was delivered at 28 weeks' gestation for nonreassuring fetal status and superimposed preeclampsia. All pregnancies were complicated by renal insufficiency; however, the 2 subjects with poor obstetric outcome had preconception serum creatinine levels greater than 1.5 mg/dL and creatinine clearances less than 40 mL/min. Pregnancies complicated by second-trimester vasoconstriction and moderate renal insufficiency are at risk for preeclamspia, fetal growth restriction, and fetal demise. Good obstetric outcome can occur in women with mild renal insufficiency and well-controlled chronic hypertension. Improved hypertensive control preconception may decrease the risk for preeclampsia and poor obstetric outcome.
authors.affiliation: Department of Obstetrics and Gynecology and Medicine, Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA 98195-6460, USA.
authors.forename: D B
authors.initials: DB
authors.lastname: Carr
authors.forename: A M
authors.initials: AM
authors.lastname: Larson
authors.forename: B C
authors.initials: BC
authors.lastname: Schmucker
authors.forename: D A
authors.initials: DA
authors.lastname: Brateng
authors.forename: R L
authors.initials: RL
authors.lastname: Carithers
authors.forename: T R
authors.initials: TR
authors.lastname: Easterling
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section; D003404:Creatinine / Q000097:blood; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation / Q000502:physiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology; D011256:Pregnancy Outcome; D051437:Renal Insufficiency / Q000503:physiopathology; D016559:Tacrolimus / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D003404:Creatinine; D016559:Tacrolimus