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| ORIGINAL ARTICLE |
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| Year : 2020 |
Volume
: 31 | Issue : 2 | Page
: 368-379 |
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Pregnancy-related acute kidney injury and urological comorbidities in morbidly adherent placenta: A potential challenge to AKI-0by25
Harmandeep Singh Chahal1, Sunil Kumar Juneja2, Simran Kaur3, Bakul Kochar2, Sandeep Sharma1, Vikas Makkar3
1 Department of Urology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
2 Department of Obstetrics and Gynecology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
3 Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
Correspondence Address:
Simran Kaur
Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana - 141 001, Punjab
India
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DOI: 10.4103/1319-2442.284011 PMID: 32394909 
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Pregnancy-related acute kidney injury (PRAKI) and urological complications can significantly increase the maternal morbidity and mortality, and morbidly adherent placenta (MAP) has been found to increase the risk of both. This is a four-year prospective study, conducted on patients with MAP. Baseline parameters (demographic/antenatal/perinatal), operative details (obstetric/urological/hemostatic), peri-operative complications (AKI/urological), and maternal/fetal outcomes were studied till six weeks after delivery. Statistical analysis was done using IBM SPSS Statistics version 21.0, and P <0.05 was considered statistically significant. Out of the 5475 deliveries conducted in the study period, 64 had adherent placentation. AKI occurred in 39.1% of patients, with severe AKI (AKIN-2, 3) in 10.9%, and significantly higher incidence in placenta percreta (P = 0.021, relative risk [RR] - 2.34), urological injuries (P = 0.001, RR - 2.86), and high blood loss (P = 0.001) on univariate analysis, but placenta percreta was the most statistically significant factor P = 0.049) on multivariate analysis. Urological involvement/injuries requiring intervention were encountered in 22 patients, with statistically significantly high incidence in placenta previa (P = 0.023, RR - 1.62), placenta percreta (P = 0.000, RR - 17.18), and patients undergoing hysterectomy (P = 0.000, RR - 2.01) on univariate analysis, but placenta percreta was most statistically significantly implicated on multivariate analysis (P = 0.017). AKI and urological injuries significantly increased the need for intensive care and days of hospitalization. On six-week follow-up, all AKI patients recovered completely; no urinary leak or vesico-vaginal fistula was seen in urologically intervened patients and no maternal mortality occurred. There is an alarmingly high incidence of PRAKI and urological complications in MAP, posing a great threat to their worldwide improving statistics. Awareness of this condition among renal fraternity can significantly improve the maternal renal and overall prognosis.
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