# data[].attributes.headline
SID:1502114     1.Is she taking on-going medication that could affect this
pregnancy?

Risk of raised BP leading to
eclampsia/pre-eclampsia

Could the pregnancy
exacerbate decline despite being stable at the moment

Reduced renal function during
pregnancy could lead to higher chance of miscarriage, preterm birth, IUGR
leading to respiratory distress syndrome. Kate may also be prone to more UTI’s
. 2. Antentally Kate would need to see both obstetricians and
physicians, she would need to have a plan that monitored her closely throughout
her pregnancy looking at changes to blood pressure, urinalysis and monitoring
any changes from the norm. Due to her history, Kate is likely to be under a
specialist team anyway, they would need input in her care. She should also
receive regular input from her community midwife. The fetus would need to be
monitored for growth, circulation.

 

3. Kate would be able to have a normal vaginal delivery but
on a high risk labour ward due to the need for continuous fetal monitoring.
Kate should be monitored closely for signs of infection, steroids should be
considered for the fetus due to the risk of pre-term birth. The neonatal
team/paediatricians should be made aware of the case.

 

4. Postnatally Kate would regular blood pressure monitoring
as well as renal function tests. She should continue to see the specialists
until they are happy with her health and contraception should be discussed with
Kate promptly after delivery. The baby would need to be assessed in line with
regular post natal care, except when any issues have been identified. 

 

5.The midwives role in this case would be to support and
re-assure Kate regularly throughout the pregnancy. The midwife should be an
advocate for Kate, ensuring that the specialists aren’t making all the
decisions for her and that she has a say in the plan, allowing Kate to feel
empowered and in control. Kate should be advised to regularly attend all
appointments and the midwife should undertake regular BP checks and urinalysis,
but also ensuring Kate is well emotionally as well as physically. Always
referring on when there are any concerns.

# data[].attributes.subject
SID:1502114     1.Is she taking on-going medication that could affect this
pregnancy?

Risk of raised BP leading to
eclampsia/pre-eclampsia

Could the pregnancy
exacerbate decline despite being stable at the moment

Reduced renal function during
pregnancy could lead to higher chance of miscarriage, preterm birth, IUGR
leading to respiratory distress syndrome. Kate may also be prone to more UTI’s
. 2. Antentally Kate would need to see both obstetricians and
physicians, she would need to have a plan that monitored her closely throughout
her pregnancy looking at changes to blood pressure, urinalysis and monitoring
any changes from the norm. Due to her history, Kate is likely to be under a
specialist team anyway, they would need input in her care. She should also
receive regular input from her community midwife. The fetus would need to be
monitored for growth, circulation.

 

3. Kate would be able to have a normal vaginal delivery but
on a high risk labour ward due to the need for continuous fetal monitoring.
Kate should be monitored closely for signs of infection, steroids should be
considered for the fetus due to the risk of pre-term birth. The neonatal
team/paediatricians should be made aware of the case.

 

4. Postnatally Kate would regular blood pressure monitoring
as well as renal function tests. She should continue to see the specialists
until they are happy with her health and contraception should be discussed with
Kate promptly after delivery. The baby would need to be assessed in line with
regular post natal care, except when any issues have been identified. 

 

5.The midwives role in this case would be to support and
re-assure Kate regularly throughout the pregnancy. The midwife should be an
advocate for Kate, ensuring that the specialists aren’t making all the
decisions for her and that she has a say in the plan, allowing Kate to feel
empowered and in control. Kate should be advised to regularly attend all
appointments and the midwife should undertake regular BP checks and urinalysis,
but also ensuring Kate is well emotionally as well as physically. Always
referring on when there are any concerns.

# data[].attributes.body
1. It is noted that Kate has had a previous renal transplant after suffering chronic renal failure in her first pregnancy. After having a transplant it now means that during this pregnancy Kate has a higher chance of developing conditions such as pre-eclampsia due to previously having impaired filtration and perfusion of her kidneys. Kate already suffers from hypertension which is another condition which can develop as a result of renal disease. It is noted that Kate suffers from asthma and it should be recognised that some hypertensive drugs such as beta blockers and ACE inhibitors can have a problematic effect on individual suffering with asthma.The two conditions (pre-eclampsia and hypertension) can both relate in an effect on placental perfusion causing IUGR which can affect fetal well-being resulting in pre-term delivery in some cases. Kate is also at higher risk of developing a UTI which again has a relation to IUGR and premature delivery.
2. Kate's antenatal care should be shared with nephrologists, obstetricians and if necessary surgeons and paediatricians which will then offer the best chance of a favourable outcome in Kate and her baby. She should see her midwife frequently for blood pressure checks and urinalysis' to look for developmental signs of pre-eclampsia such as a high BP or proteinuria along with monitoring of Kate's daily well-being. Kate should have frequent growth USS' to asses fetal growth, amniotic fluid volume, and doppler. USS assessment of uterine, umbilical, and fetal cerebral vessels, and ductus venosus provide important information regarding fetal well-being due to the high risk of her developing IUGR. Kate would have consultant led care having regular appointments with an obstetrician and she may also require appointments with a nephrologist to monitor her renal function (this may include GFR testing). At her midwife appointments Kate should be informed of the risks and early signs of developing conditions such as pre-eclampsia due to her past medical history, she should be informed of the risks to the baby if IUGR was to develop and it is important that Kate feels supported throughout her pregnancy. A discussion on VBAC should be arranged and VBAC classes should be advised if available.
3. Kate is able to have a vaginal birth although this would be facilitated on the labour ward as she requires continuous fetal monitoring due to the risk of IUGR and she will also require frequent BP checks throughout her labour along with all other routine observations. She may have had steroids to support the baby's lung development and a paediatrician plan may be in place to facilitate the baby after birth due to the risk of pre-term delivery or low birth weight due to risk of IUGR, which can relate in respiratory distress syndrome. If a caesarean section becomes necessary it is advisable that there is contact with renal transplant surgeons and Kate should be re-informed of the risks even after having a previous section in her first pregnancy.

4. Routine postnatal care should be performed by a midwife, including frequent BP checks and urinalysis' to continuously observe renal function during Kate's recovery period. She may also require continuation of care from nephrologist's to asses her renal function after pregnancy. The baby's growth and development should be closely monitored due to the IUGR risk in pregnancy and support should be given to Kate including further counselling regarding subsequent pregnancies.
5. The role of the midwife is to provide holistic care to Kate throughout her pregnancy. The midwife should give support and evidence-based advice to Kate and should ensure she has a clear understanding of why a multi-disciplinary team is relevant in her care during this pregnancy and that she is happy with this plan. The midwife should encourage Kate to attend all her appointments and those appointments with the different professionals and inform her of its importance in the care for her and the baby. The midwife should provide reassurance for Kate as the care plan may seem intense and stressful during this pregnancy and should arrange further counselling if Kate feels this would be helpful

# data[].attributes.body
1502826
1. Complications may include impaired renal function, recurrant UTIs, raised BP, and fetal growth retardation.
2. She should have consultant led care with a renal specialist and obstetrician, in addition to regular midwife appts should she choose to do so. During the antenatal period she will need regular urinalysis, BP checks and GROW scans, perhaps more frequently than other women. Discussion of VBAC needed.
3. In labour BP will need to be monitored throughout, as well as urinalysis and blood tests to check ongoing kidney function. Prolonged labour may be avoided if BP rises or due to the VBAC.
4. Postnatally she should continue to be monitored for kidney function, BP and UTI occurance. If there was any fetal compromise due to IUGR, observations should be regularly done to establish wellbeing. Possible blood glucose testing.
4. Midwife's role is to educate the woman about the reasons for referral to other professionals, as well as to reassure her that midwifery care is still available to her. Reassurance that her pregnancy and birth will be kept as normal as is possible. Focus on the wellbeing of mother and infant as the desirable outcome, rather than the route necessary to achieve it. Support and encouragement during labour as normal. Close postnatal care and liaison with the multidisciplinary team when handover of care takes place at discharge.

# data[].attributes.body
Potential Maternal and Fetal Complications: Due to Kate previously having a renal transplant, she is at risk of developing hypertension again as well as urinary tract infections. Kate should be made aware antenatally that fetal complications include preterm premature rupture of membranes, consequently leading to pre-term birth due to IUGR, therefore the baby will have a low birth weight and may suffer from respiratory distress syndrome. Should Kate developed a renal disease during the pregnancy, there is a risk of her developing pre-eclampsia.

Antenatal Care: During antenatal clinic appointments, close attention should be given to blood pressure readings and urinalysis as well as the daily well being of Kate. Regular growth scans will be needed to monitor the growth of the fetus due to the fetus being at risk of growth restriction and low birth weight. The monitoring of her asthma must be taken into consideration as should Kate experience a renal failure in this pregnancy, the respiratory system will be affect and she may become at risk of developing pulmonary edema or pulmonary failure. Information about early signs of pre-eclampsia, infection and the risk of early delivery should be given frequently, ensuring Kate feels aware and supported. Kate's renal function should be regularly monitored, this may be through regular appointments with a nephorology team including a consultant obstetrician who specialises in maternal medicine, as well as visits to a consultant who specialises in kidney transplant and pregnancy.

Labour: For women who have had a previous renal transplant, vaginal delivery is preferred. Fluid overload should be avoided to prevent infection. If a Cesarean section is planned, it is advisable that there is an involvement with renal transplant surgeons. In the case of a pre-term birth, the fetus would need to be on steroids to aid the growth and development. Further support from paediatricians would be provided to help the fetus should it experience any respiratory problems.

Postnatal Care: Routine postnatal midwife visits would be given, monitoring the well-being of Kate and the baby. Blood pressure readings should continue to be monitored as well as the renal functioning. The baby's weight and growth should also be monitored. Postnatally, the established care with the nephrology team should continue. Appropriate contraception advice to be given and continued support.

Midwife Role: The midwife should give a continuity of care, providing support and reassurance. Also it should be ensured that an appropriate plan of care is put in place for Kate and that she attends all scheduled appointments. Further counselling may need to be arranged if necessary.

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maternal complications: Kate has already had a transplant after her previous pregnancy; a further pregnancy can increase the chance of pre-eclampsia and can result in permanent damage to her kidneys.  There is a risk of pre-term birth due to IUGR. She has asthma so this should be monitored.
Fetal complications: IUGR due to baby being compromised with the placental perfusion affected. the kidney has a part to play in activating vitamin D so the baby my not get enough in utero.
Care: Kate should be under consultant care within the renal specialist area, with regular renal function tests and blood pressure checks. Extra scans would be needed to also monitor the growth of the fetus due to the risk of growth restriction. Her asthma also needs monitoring with regular checks at the clinic.
Labour: Kate is considered high risk so she would be in the central delivery suite, and not low risk suite. The fetus would need steroids due to the risk of premature birth and paed would need to be available after the birth incase respiratory help is needed.
Postnatal: Kate would need continuous checking of her blood pressure, and renal function, which could be done in the community if her condition is stable. Consultant involvement would be needed postnatally to ensure she doesnt need another transplant. If the baby is premature it may spend some weeks in NNU to be monitored for growth and other renal related problems and infections.
Role of the midwife: to support Kate at this anxious time. She had her previous baby early so may be worried this may happen again, and she will need further surgery. She needs to attend all the consultant appointments and ensure they have a good plan of care organised for her, and that all her questions are answered.

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1. Maternal complications in pregnancy include Kate being prone to infection due to immunosuppressive drugs and also urinary tract infections. She may also suffer from anaemia and hypertension.

Kate will have to be made aware that she may have a preterm delivery and that the fetus may have IUGR and may suffer from respiratory distress syndrome. It may also suffer with adrenocortical insufficiency, a deficiency of platelets in the blood, a reduced amount of white blood cells, cytomegalovirus and other infections.

2. Kate should be cared for antenatally, by a doctor who specialises in kidney care and an obstetrician. She can still have regular midwifery care but will need to have regular blood pressure checks as well as renal function tests. The condition of the fetus will also have to be consistently monitored, monitoring growth and circulation.

3. Kate can labour naturally, however, steroid therapy should be increased and antibiotics given if surgery is needed including an episiotomy.

4. Kate should have follow up appointments to check her renal function, blood pressure and her continuation of the immunosuppressant drugs. She should also have her normal postnatal checks by the midwife. The baby will also need to have some checks in case they suffer from any of the above (Answer 1).

5. Kate may need more support from the midwife throughout the pregnancy as she may be concerned about the baby being unwell when it is born or be fearful that her kidneys may be affected again.

She will need to be advised that she should attend all of her appointments to make sure that she is in the best possible health for her and the baby.