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Maternal Mortality due to Pregnancy-Related Acute Kidney Injury (PRAKI); A Study of the Epidemiological Factors and Possible Solutions

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The Journal of Obstetrics and Gynecology of India Aims and scope Submit manuscript

Abstract

Objective

This prospective observational study aimed to explore the epidemiology, causes, and outcomes of Pregnancy-Related Acute Kidney Injury (PRAKI) in a tertiary care center in North India and identify risk factors for mortality.

Methods

We enrolled adult obstetric patients with PRAKI according to Kidney disease improving global outcomes criteria between February 2021 and April 2022. Data on demographic characteristics, clinical features, causes of PRAKI, and outcomes were collected. Univariate and multivariate analyses were conducted to identify factors associated with mortality. PRAKI prevention bundles for patients and obstetricians were proposed on the basis of key findings of the study.

Results

Of the 89 patients included, pre-eclampsia/eclampsia/HELLP syndrome, hemorrhage, and sepsis were the primary causes of PRAKI. Maternal mortality was alarmingly high at 24.7%. Factors independently associated with mortality were the need for vasopressor support and renal replacement therapy.

Conclusion

This study highlights the urgent need for preventive and therapeutic interventions to reduce maternal mortality related to PRAKI. On the basis of the key findings, PRAKI prevention bundles were proposed. The PRAKI prevention (patient) bundle included regular BP measurement during ANC visits, healthcare check-up if there is fever or drop in urine during pregnancy or immediate postpartum. The PRAKI prevention (obstetrician) bundle included regular BP measurement, urine culture, avoidance of nephrotoxic agents and hourly urine output monitoring during delivery and immediate postpartum. Implementing preventive measures, enhancing obstetric intensive care units, and improving antenatal care compliance may help mitigate the devastating impact of PRAKI.

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Authors and Affiliations

  1. Department of Medicine, King George Medical University (KGMU), Lucknow, 226003, India

    Medhavi Gautam, Himanshu Dandu & Virendra Atam

  2. Department of Critical Care Medicine, King George Medical University (KGMU), Lucknow, 226003, India

    Armin Ahmed & Avinash Agrawal

  3. Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226003, India

    Prabhakar Mishra

  4. Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226003, India

    Afzal Azim

  5. Department of Obstetrics and Gynaecology, Era’s Lucknow Medical College and Hospital, Lucknow, 226003, India

    Ayesha Ahmad

  6. Department of Obstetrics and Gynaecology, King George Medical University (KGMU), Lucknow, 226003, India

    Shyam Pyari Jaiswar

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  1. Medhavi Gautam
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Correspondence to Armin Ahmed.

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Ethical Approval

Ethical approval was granted by the ethical committee of King George Medical University.

Human and Animal Rights

Research involves human participants but since it is an observational study there was no direct risk to participants. Study was approved by the hospital ethics committee.

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Informed consent has been taken from all participants at the time of inclusion in the study.

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Dr. Medhavi Gautam is a Associate Professor. Dr. Armin Ahmed is a Additional Professor. Dr. Prabhaker Mishra is a Professor. Dr. Afzal Azim is a Professor. Dr. Ayesha Ahmad is a Professor. Dr. Himanshu Dandu is a Professor. Dr. Avinash Agarwal is a Professor. Dr. Virendra Atam is a Professor. Dr. Shyam Pyari Jaiswar is a Professor.

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Gautam, M., Ahmed, A., Mishra, P. et al. Maternal Mortality due to Pregnancy-Related Acute Kidney Injury (PRAKI); A Study of the Epidemiological Factors and Possible Solutions. J Obstet Gynecol India (2024). https://doi.org/10.1007/s13224-024-01942-4

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