Chinese Medical E-ournals Database

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2024, Vol. 20 ›› Issue (02): 133 -139. doi: 10.3877/cma.j.issn.1673-5250.2024.02.002

Pregnancy Complications

Value of multidisciplinary team management in perinatal period for pregnant women with chronic kidney disease

Yisi Chen1, Min Liang1, Hongyu Li1, Xue Xia1, Yanxi Liu1, Chenqu Li1, Dan Wang1,()   

  1. 1. Department of Obstetrics and Gynecology, the First Affiliated Hospital of Army Medical University, Chongqing 400030, China
  • Received:2024-01-04 Revised:2024-03-09 Published:2024-04-01
  • Corresponding author: Dan Wang
  • Supported by:
    Joint Medical Research Project of Chongqing Municipal Science and Technology Bureau and Chongqing Municipal Health Commission(2021MSXM082)
Objective

To explore the clinical effect of multidisciplinary team (MDT) management model in pregnant women with chronic kidney disease (CKD) during perinatal period.

Methods

Seventy pregnant women who gave birth at Department of Obstetrics and Gynecology, the First Affiliated Hospital of Army Medical University from January 2018 to December 2022 and were diagnosed with CKD before pregnancy or at gestational age < 25 weeks were selected as the research subjects. According to the perinatal management model of CKD pregnant women, they were included into study group (n=40, receiving MDT management intervention measures during perinatal period) and control group (n=30, receiving an obstetric single-department joint management intervention measures by medical and nursing staff during perinatal period). General clinical data, renal function indicators such as creatinine concentration and 24 h urine protein quantification before and after perinatal intervention (the first and third trimester pregnancy), pregnancy complications, and pregnancy outcomes of two groups were collected by retrospective study method, and were compared by independent-samples t test, Mann-Whitney U test, and chi-square test or continuity correction chi-square test or Fisher′s exact probability method. This study has been approved by the Medical Ethics Committee of the First Affiliated Hospital of Army Medical University [Approval No. (B)KY2023085].

Results

①There were no statistical differences in general clinical data such as age, height, weight and body mass index (BMI) three months before pregnancy between two groups (P>0.05). ②Before intervention, there were no statistical differences between two groups in renal function indicators such as 24 h urine protein quantification and creatinine concentration in the first trimester pregnancy (P>0.05). After intervention, the 24 h urinary protein quantification of CKD pregnant women in the third trimester pregnancy of study group was significantly lower than that of control group, and the difference was statistically significant (Z=-3.09, P=0.002). ③The total incidence of pregnancy complications of study group was 50.0% (20/40), which was significantly lower than that of control group 86.7% (26/30), and the difference was statistically significant (χ2=10.23, P=0.001). The incidence of thyroid dysfunction in study group was 5.0% (2/40), which was significantly lower than that of control group 30.0% (9/30), and the difference was statistically significant (χ2=6.31, P=0.012). ④The total incidence of adverse pregnancy outcomes such as premature birth, induced abortion, and spontaneous abortion in study group was 12.5% (5/40), which was significantly lower than that of control group 43.3% (13/30), and the difference was statistically significant (χ2=8.53, P=0.008). ⑤The birth weight, gestational age at birth, and Apgar scores at 1, 5, and 10 min after birth of newborns delivered by CKD pregnant women in the study group all were significantly higher than those in the control group, and the differences were statistically significant (t=-2.90, P=0.007; t=-2.33, P=0.027; t=-2.37, P=0.027; t=-2.13, P=0.042; t=-2.07, P=0.048).

Conclusions

Adopting intervention measures of MDT management model during perinatal period for CKD pregnant women can effectively reduce the incidence of perinatal complications, alleviate renal burden, reduce incidence of adverse pregnancy outcomes and premature birth.

表1 2组CKD孕妇一般临床资料比较(±s)
表2 2组CKD孕妇干预前(早孕期)、后(晚孕期)24 h尿蛋白定量、肌酐浓度比较[M(Q1Q3)]
表3 2组CKD孕妇妊娠期并发症发生情况比较[例数(%)]
表4 2组CKD孕妇妊娠结局比较[例数(%)]
表5 2组CKD孕妇新生儿结局比较
[1]
Ammirati AL. Chronic kidney disease[J]. Rev Assoc Med Bras (1992), 2020, 66(Suppl 1): s03-s09.DOI: 10.1590/1806-9282.66S1.3.
[2]
Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey [J]. Lancet, 2012, 379(9818): 815-822. DOI: 10.1016/S0140-6736(12)60033-6.
[3]
Piccoli GB, Zakharova E, Attini R, et al. Pregnancy in chronic kidney disease: need for higher awareness. A pragmatic review focused on what could be improved in the different CKD stages and phases[J]. J Clin Med, 2018, 7(11): 415. DOI: 10.3390/jcm7110415.
[4]
Ainsworth J. Exploring medical students′ early experiences of interacting with the multi-disciplinary team (MDT): a qualitative study[J]. MedEdPublish (2016), 2021, 10: 30. DOI: 10.15694/mep.2021.000030.1.
[5]
林容,翁晓英,林靓. 多学科团队合作诊疗在胎盘植入性疾病中的临床应用[J]. 创伤与急诊电子杂志2022, 10(2): 91-96. DOI: 10.16746/j.cnki.11-9332/r.2022.02.009.
[6]
上海市肾内科临床质量控制中心专家组. 慢性肾脏病早期筛查、诊断及防治指南(2022年版)[J]. 中华肾脏病杂志2022, 38(5): 453-464. DOI: 10.3760/cma.j.cn441217-20210819-00067.
[7]
白伶伶. 同伴支持干预对妊娠期高血压患者负性情绪,应对方式及妊娠结局的影响[J].医学临床研究2020, 37(2): 3. DOI: 10.3969/j.issn.1671-7171.2020.02.052.
[8]
林建华. 妊娠合并结构异常性心脏病并发产后出血MDT管理专家共识[J]. 中国实用妇科与产科杂志2019, 35(5): 528-535. DOI: 10.19538/j.fk2019050111.
[9]
Eskandar J, Lucas A, Dixon A, et al. Pregnancy and family planning in women with kidney disease[J]. Kidney Int Rep, 2024, 9(5): 1236-1243. DOI: 10.1016/j.ekir.2024.02.1438.
[10]
Rao A, Brewster UC. Pregnancy in chronic kidney disease: acute kidney injury in pregnant women and management of chronic kidney disease in the pregnant patient[J]. Med Clin North Am, 2023, 107(4): 717-726. DOI: 10.1016/j.mcna.2023.03.005.
[11]
王妮妮,陶于洪. 慢性肾脏病与甲状腺功能减退研究现状 [J/OL]. 中华妇幼临床医学杂志(电子版), 2019, 15(3): 233-238. DOI: 10.3877/cma.j.issn.1673-5250.2019.03.001
[12]
Zhang JJ, Ma XX, Hao L, et al. A systematic review and Meta-analysis of outcomes of pregnancy in CKD and CKD outcomes in pregnancy[J]. Clin J Am Soc Nephrol, 2015, 10(11): 1964-1978. DOI: 10.2215/CJN.09250914.
[13]
Li Z, Chen S, Tan Y, et al. Twenty-four-hour proteinuria levels are associated with adverse pregnancy outcomes among women with CKD[J]. Clin Kidney J, 2023, 16(10): 1634-1643. DOI: 10.1093/ckj/sfad44.
[14]
Oei JL, Kandasamy Y. Population data suggest persistently high risk of pregnancy complications in women with chronic kidney disease[J]. Evid Based Nurs, 2021, 25(3): 106. DOI: 10.1136/ebnurs-2021-103448.
[15]
Al Khalaf S, Bodunde E, Maher GM, et al. Chronic kidney disease and adverse pregnancy outcomes: a systematic review and Meta-analysis[J]. Am J Obstet Gynecol, 2021, 226(5): 656-670. DOI: 10.1016/j.ajog.2021.10.037.
[16]
Hopkins J, Hewawasam E, Aldridge E, et al. South Australian prospective cohort study evaluating outcomes of maternal kidney and cardiac disease in pregnancy: a protocol[J]. BMJ Open, 2022, 12(2): e059160. DOI: 10.1136/bmjopen-2021-059160.
[17]
姚丽,薛伟. 慢性肾脏病患者妊娠管理的研究进展[J]. 中华医学信息导报2020, 35(7): 22. DOI: 10.3760/cma.j.issn.1000-8039.2020.07.131.
[1] Qianmei Li, Guannan He, Jing Zhao, Xi Chen, Yuying Tang, Liqiong Ma, Rong Liang, Tao Yuan, Mingxing Li. Placental microvascular flow imaging characteristics and prognosis of early low-risk and high-risk pregnancies[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(07): 726-732.
[2] Ziyang Liu, Jianjian Cui, Yin Zhao. Current research status on obstetric disseminated intravascular coagulation and its scoring system[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 511-518.
[3] Jiangyan Xie, Yafei Wang, Fang He. Pregnancy complicated with thrombotic thrombocytopenic purpura:two cases report and literature review[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 556-563.
[4] Xiaoyan Han, Hua Yang. Relationship between low level of serum placental growth factor in the second trimester pregnancy women and adverse fetal prognosis[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(04): 398-402.
[5] Jiali Du, Rui Bao, Chunhong Qiao, Wei Han. Construction of a prediction model for adverse pregnancy outcomes after emergency cervical cerclage in pregnant women with cervical incompetence during the second trimester[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(04): 403-409.
[6] Jing Zhang, Chang Liu, Chengge Hua. Progress in the treatment of oral diseases during pregnancy[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2024, 18(05): 340-344.
[7] Jingyun Xu, Bo Ding, Yuhui Jiang, Yang Shen. The practice and consideration of single-site laparoscopic operation during pregnancy[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(05): 262-266.
[8] Long Zhang, Shanke Sun, Wei Xu, Wenzhu Li, Junda Li, Yongquan Chi, Guangsheng He, Feng Cheng, Xuehao Wang, Jianhua Rao. Clinical efficacy of laparoscopic splenectomy in the treatment of hematological diseases[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(06): 870-875.
[9] Quality Control Center of Jiangxi Province Neurosurgery. Expert consensus on multidisciplinary collaborative prevention and treatment of cardiogenic stroke in Jiangxi Province[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2024, 14(05): 264-277.
[10] Huihui Yu, Zongzhi Yin. Gastric perforation during pregnancy[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2024, 13(04): 209-213.
[11] Shan Lu, Yunshan Yao, Seni Liao, Zien Chen, Yijian Zhang, Jianhao Lan, Wei Wei, Yanyang Liu, Yanhong Chen, Duijin Chen. Clinical study of 100 cases of suspected pregnancy complicated with acute appendicitis[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2024, 13(04): 214-219.
[12] Wenyan Wang, Jianlan Zheng, Lici Zhu. Clinical study on the risk of pregnancy and perinatal period after in vitro fertilization and embryo transfe[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2024, 13(04): 220-226.
[13] Xiaojing Hu, Hua Zhang. Diagnosis and treatment of ovarian cyst torsion during pregnancy[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2024, 13(04): 197-201.
[14] Pu Li, Xiujie Sheng. Management of pregnancy complicated with cervical cancer[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2024, 13(04): 202-208.
[15] Zhongxia Hang, Zhaoxia Wang, Qin Sun, Ni Li. The application of serum Irisin,TSH and Hcy in diagnosing gestational hypothyroidism[J]. Chinese Journal of Diagnostics(Electronic Edition), 2024, 12(04): 265-269.
Viewed
Full text


Abstract