Management of pregnant transplant recipients
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What is included in medical and obstetric management of pregnant transplant recipients ?
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@cicely Medical management of pregnant transplant recipients includes the following:
Patient self-monitoring of daily blood pressure
Aggressive management of hypertension: The drug of choice is methyldopa ; second-line agents include clonidine and calcium channel alpha blockers ; contraindicated drugs include angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs)
Close monitoring of graft function; if rejection is suspected, consider biopsy
In cases of acute rejection, steroids are the preferred drugs
Obstetric management of pregnant transplant recipients includes the following
Frequent evaluations, preferably every 2 weeks
Vaginal delivery (preferred): Usually delayed until labor onset unless maternal/fetal indications for induction exist; cesarean delivery is only indicated for obstetric reasons (in such cases, avoid injury to the allograft by knowing its exact location)
Antibiotic prophylaxis for all surgical procedures
Increased steroid dose at labor onset to overcome the stress of labor and prevent postpartum transplant rejection
Immunosuppression in pregnant transplant recipientsImmunosuppressive agents used to treat pregnant transplant recipients include the following:
Corticosteroids: For induction, acute rejection, and maintenance immunosuppression
Cyclosporine (cyclosporin A): To prolong the survival of liver transplants
Azathioprine: Mainly for maintenance immunosuppression
Mycophenolate mofetil: For maintenance immunosuppression and for treating chronic rejection
Tacrolimus: For immunosuppression in solid organ transplant recipients
Sirolimus: For immunosuppression in solid organ transplant recipients
Anti-CD3 (OKT3): (Rare) To treat acute rejection in pregnant transplant recipients
The safety of these immunosuppressive agents for use in pregnancy has not been established, except for azathioprine and mycophenolate mofetil—both are unsafe in pregnancy. Clinicians are strongly encouraged to report all cases of pregnancy to the National Transplantation Pregnancy Registry (NTPR) in order to provide more updated information on the safety of newer immunosuppressive drugs and their adverse effects on mothers and fetuses.