Problemsspecial considerations Immunosuppressive therapy

All transplant patients are at risk of organ rejection and therefore require long-term immunosuppressive therapy. There is no evidence that pregnancy itself increases the risk of rejection, which, in the case of renal transplants, is about 10 in the first year and up to 40 after 5 years. Infections, both bacterial and viral, are more common because of the immuno-suppressed state, with urinary tract infections already more common during pregnancy being the most frequent infectious complication....

Management options

It is important that a full history is taken and neurological examination performed, since there are many causes of postpartum headache Table 44.1 . Neurological referral may be wise in difficult cases. PDPH is suggested by a history of dural puncture and typical symptoms, especially the postural element. However, it may follow apparently unremarkable epidural anaesthesia the incidence is unknown, although it may involve a number of factors including lack of recognition at the time of dural...

Modification of labour pain Psychological factors

There is considerable evidence that preparation for childbirth can significantly modify the degree of pain experienced. This was the basis of the 'childbirth without fear' movement, which was popular in the 1960s. Although there can be little doubt that fear, fatigue and anxiety enhance pain perception, for the majority of mothers it is misleading to suggest that good antenatal education will lead to painless childbirth. Such expectations may in fact have the reverse effect, since the mother...

Central venous pressure monitoring

Insertion of a central venous catheter to measure right atrial pressure may give valuable information in women with coexisting cardiac disease see relevant chapters for further details . Most protocols for managing women with severe preeclampsia also suggest insertion of a CVP line to aid in fluid management, although it is important to realise that the information obtained right atrial pressure may not accurately reflect left atrial pressure. The least invasive technique is recommended for...

Acquired thrombophilia

The antiphospholipid syndrome is the most common cause of acquired thrombo-philia. Identified autoantibodies include lupus anticoagulant and anticardiolipin antibodies. However, there is some evidence that other as yet unidentified auto-antibodies may cause thrombosis and fetal loss in pregnancy. The lupus anticoagulant is so called because it causes a prolongation of the activated partial thromboplastin time even when diluted because the autoantibody binds to phospholipid in the assay ....