The most common association of renal failure in obstetrics is?
Ans. A. PIH. (Ref Williams Obstetrics. 22nd ed. Chapter 48; pg. 1255-1258; Table 48-6).Today, renal failure is most often associated with severe preeclampsia - eclampsia [with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome) developed renal failure).Obstetrical hemorrhage, notably placental abruption, when it develops either alone or in concert with severe preeclampsia, is strongly linked to severe renal failure. "Abruption placentae, with either overt or concealed hemorrhage, appears to be the most common antecedent event causing ARF."# Management- Oliguria is an important sign of acutely impaired renal function. In obstetrical cases, both prerenal and intrarenal factors are commonly operative. For example, with total placental abruption, severe hypovolemia is common from massive hemorrhage.- Superimposed preeclampsia may cause oliguria. Intense consumptive coagulopathy commonly triggered by an abruption might impede intrarenal microcirculation.- When azotemia is evident and severe oliguria persists, hemodialysis should be initiated before marked deterioration of general well-being occurs.- Early dialysis appears to reduce appreciably the mortality and may enhance the extent of recovery of renal function. With time, renal function usually returns to normal or near normal.Additional Educational points:# PLACENTAL ABRUPTION is the most common cause of severe consumptive coagulopathy in obstetrics.# Nulliparity, episiotomy, and forceps delivery are the most commonly associated risk factors with PUERPERAL HEMATOMAS# The most common cause of uterine rupture is separation of a previous cesarean hysterotomy scar.# The most commonly implicated contaminant of red cells in transfusion blood components is Yersinia enterocolitica.
PIH
Sepsis
Abruptio placentae
HELLP syndrome
Miscellaneous (Gynae)