Dr Nishanta Tangirala1,5, DR ERANDI HEWAWASAM2,3, DR AMANDA POPRZECZNY5, DR CHRISTOPHER DAVIES2,3, DR ZHOUYANG LI4, DR ELIZABETH SULLIVAN4, DR STEPHEN MCDONALD1,2,3, DR SHILPA JESUDASON1,3
1Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, Australia, 2Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia, 3Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia, 4Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia, 5Women’s and Children’s Hospital, North Adelaide, Australia
Background: Delivery outcomes in the Australian pregnant dialysis and kidney transplant population are unknown.
Aim: We investigated labour and delivery outcomes for women receiving kidney replacement therapy (KRT; chronic dialysis or kidney transplantation) compared to non-KRT cohorts.
Methods: Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) was linked to perinatal datasets (all births ≥20 weeks’ gestation) in four Australian states from 1991-2013. Labour and delivery outcomes were analysed between three cohorts: non-KRT, dialysis and renal transplant.
Results: We assessed a total of 2,903,135 births (1,627,408 mothers) representing 50% of all births in Australia. Women on KRT had low rates of spontaneous labour (29.5% dialysis vs 25.7% transplant vs 59.3% non-KRT; p<0.001), with the majority undergoing planned delivery and no labour (51.4% dialysis vs 45.5% transplant vs 15.1% non-KRT; p<0.001). Caesarean delivery (CD) rates were significantly higher in the KRT cohort compared to the non-KRT cohort (64.9% dialysis vs 63.4% transplant vs 26.4% non KRT; p<0.001). Over time, CD rates have increased across all three cohorts, although more rapidly in the dialysis cohort. Diabetes and hypertension as reason for induction were higher in the KRT cohort (20% dialysis vs 31.3% transplant vs 18.1% non-KRT; p<0.001). Postpartum haemorrhage and foetal distress were also more common (p=0.006 and p=0.001 respectively). A substantial proportion of the dialysis cohort underwent delivery with general anaesthesia (35% dialysis vs 9.6% transplant vs 3.5% non-KRT; p<0.001).
Conclusion: Women receiving KRT have higher risk deliveries and more birth interventions. No labour CDs are high in this population and may be the result of patient and physician preference. This data will enhance pre-pregnancy counselling and informed decision making around delivery.
Biography:
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