Pregnant women with kidney transplants likely to deliver by cesarean section
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Key takeaways:
- Overall, 63% of transplant recipients had a cesarean delivery vs. 26% of women without a transplant.
- Among transplant recipients, 70% of deliveries were planned labor induction or cesarean.
Women with a kidney transplant may be more likely to have a cesarean section, labor-free delivery and vaginal complications than those without a transplant, according to data from an Australia-based study.
“Successful pregnancy is an important outcome of kidney transplantation,” researcher Nishanta Tangirala, MBBS, of the University of Adelaide Faculty of Health and Medical Sciences in South Australia, Australia, wrote with colleagues. “Previous Australian studies have established the higher risk of adverse maternal-fetal outcomes associated with pregnancies in transplant recipients including preterm birth, preeclampsia and excess perinatal morbidity.” Cesarean sections among women with a kidney transplant remain between 50% and 60% internationally, they added, “yet the underlying factors driving these rates are not well understood.”
Researchers analyzed data on 2,946,851 births from 1,627,408 mothers in Australia and New Zealand using 1991 to 2013 data from the Australia and New Zealand Dialysis and Transplant Registry and perinatal archives. Of the cohort, the study compared 211 births from 137 mothers with active kidney transplants to births from non-transplanted mothers.
Researchers aimed to identify factors related to high cesarean section rates in certain patient populations.
Cesarean sections were more frequent and the rates of it remained elevated among transplanted patients, even after adjusting for preterm delivery and prior cesarean history, according to the researchers. Overall, 63% of the transplant recipients had a cesarean delivery vs. 26% in those without a transplant. This was steady across all gestational periods.
Furthermore, among women with a kidney transplant and a past pregnancy, 53% with no previous cesarean section had a cesarean delivery in the current term vs. 19% of those without a transplant. Mothers with a transplant had lower rates of spontaneous labor, with 30% experiencing natural labor vs. 63% of those without a transplant; 70% of deliveries among the transplant cohort were planned labor induction or cesarean vs. 36% among those without a kidney transplant.
In addition, researchers found that 45% of women with a kidney transplant had a cesarean section without labor, and these were mostly preterm deliveries. In the transplant group, hypertensive disorders and breech presentation were main factors for increased cesarean deliveries.
Non-labor cesarean section rates for fetal distress were higher among women with a transplant, whereas previous cesarean section was the main indication for non-labor cesarean sections for women without a transplant, according to researchers. Tangirala and colleagues also noted that postpartum hemorrhage and fetal distress were more prevalent among women with a kidney transplant, with rates at 13% and 18%, respectively, vs. 7% and 10%, respectively, among the non-transplant cohort.
“Overall, this study generates important hypotheses around delivery safety profiles, factors driving high cesarean section rates, outcomes after vaginal births and clinician decision-making that will form the basis for imperative future studies,” the researchers wrote. “There remain numerous unanswered questions regarding clinician and patient preference, effective ways to present information and models of integrating this knowledge into counselling practices. Addressing these gaps will be vital for improving delivery outcomes and patient care for women with kidney transplantation.”
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