Mode of Delivery in Women After Liver Transplantation

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doi:10.1016/j.transproceed.2007.09.011 Copyright © 2007 Elsevier Inc. All rights reserved.

Liver transplantation

Mode of Delivery in Women After Liver Transplantation

Z. Jabiry-Zieniewicza, K. Bobrowskaa, , B. Pietrzaka, B. Kaminskia, M. Wielgosa, M. Durlikb and K. Zieniewiczc aFirst Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, PolandbDepartment of Transplantation Medicine and Nephrology, Transplantation Institute, Warsaw, PolandcDepartment of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland. Available online 20 November 2007.

Abstract

Aim

A high rate of cesarean sections has been reported among high-risk pregnancies in liver transplant recipients. The aim of this study was to analyze the course of deliveries and the indications for cesarean sections in women after liver transplantation. Materials and Methods

From 2001 to 2006, we noted 21 deliveries in 17 liver recipients. The mean age of women was 27.9 ± 6.6 years and the mean time from transplantation to pregnancy was 4.3 ± 3.6 years. Most patients were primigravidas on tacrolimus-based immunosuppressive regimens. We retrospectively analyzed obstetric data regarding the delivery and the early puerperium. Results

We noted 6 vaginal deliveries (29%) and 15 cesarean sections (71%). Mean gestational age in the group of vaginal deliveries was 37.6 ± 2.2 weeks. No labor complications were noted. All neonates were delivered in a good state (Apgar score from 8 to 10 points) with mean birth weight of 2725 g. All cesarean sections were performed for obstetric indications: fetal distress, breech presentation, intrauterine growth retardation, or complications related to premature labor. Mean gestational age was 37.0 ± 1.9 weeks. The Apgar scores ranged from 4 to 10 points; mean birth weight was 2787 g. The mean period of hospitalization after surgical labor was 4 days longer compared with the vaginal delivery group. Conclusion

The high rate of cesarean sections (71%) in liver recipients is associated with a great incidence of obstetric complications of pregnancy. Safe and uneventful vaginal delivery is possible with growing experience in the management of pregnant transplanted women.

Address reprint requests to Dr Katarzyna Bobrowska, First Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicza Sq. 1/3, 02-015 Warsaw, Poland.

Transplantation Proceedings Volume 39, Issue 9, November 2007, Pages 2796-2799