Prospective observational study onepidemiology and outcome of acute renal failure in obstetrics

Aims and Objectives: To evaluate the incidence and causes of ARF in obstetrics as well as to see the management and outcome of ARF in obstetrics. Methodology: Prospective observational study. We included women with ARF during pregnancy due to obstetric complications such as severe pre-eclampsia, eclampsia, antepartum hemorrhage, IUFD, sepsis etc. women developing ARF during postpartum period due to post-partum hemorrhage, puerperal sepsis, anaesthetic complications during caesarean section as well as those developing ARF after septic abortion. In all women thorough history taking and physical examination were done. A detail analysis of all investigations and management were recorded. Patients were followed thoroughly till discharge or death. Parameters Studied included clinical parameters (history taking), general survey, abdominal examination, pelvic examination, speculum examination and per vaginal examination Results: Out of 9270 deliveries (May 2012-April 2013) 79 women developed, Pregnancy related ARF (PRARF) showing an incidence of 0.87%. The age of the patients ranged between 17 to 40years with a mean of 23.23±5.05 years. 40.5% from cases were below 20 years of age. Majority of them (92.44%) were poor socio-economic status. 68 out of 79 patients were illiterate. Most of the patients were presenting ARF in their first pregnancy. PRARF was mostly found in (84.81%) referred cases. The most common causative factor for PRARF in the present study was sepsis 32 (40.51%) mainly due to puerperal sepsis, followed by PIH 20(25.32%) and postpartum hemorrhage17 (21.53%). 41 patients did not require haemodialysis, they were treated conservatively. On the other hand 2(2.53%) required dialysis more than 10 times. Most patients recovered completely. 59(74.68%), 13 (16.46%) patients died and 7(8.86%) patients left against medical advice. The case fatality rate was 16.46%. Conclusion: Pregnancy related acute renal failure is a rare but serious complication occurring during pregnancy. It was most commonly found in illiterate, poor, young, and primi-mothers. It was mostly seen in referred cases. Sepsis was the leading cause of pregnancy related acute renal failure followed by pregnancy induced hypertension and postpartum hemorrhage. Almost half of the patients needed hemodialysis. Case fatality rate is high.