Value of multidisciplinary team management in perinatal period for pregnant women with chronic kidney disease
Objective To explore the clinical effect of multidisciplinary team(MDT)management model in pregnant women with chronic kidney disease(CKD)during perinatal period.Methods Seventy pregnant women who gave birth at Department of Obstetrics and Gynecology,the First Affiliated Hospital of Army Medical University from January 2018 to December 2022 and were diagnosed with CKD before pregnancy or at gestational age＜25 weeks were selected as the research subjects.According to the perinatal management model of CKD pregnant women,they were included into study group(n=40,receiving MDT management intervention measures during perinatal period)and control group(n=30,receiving an obstetric single-department joint management intervention measures by medical and nursing staff during perinatal period).General clinical data,renal function indicators such as creatinine concentration and 24 h urine protein quantification before and after perinatal intervention(the first and third trimester pregnancy),pregnancy complications,and pregnancy outcomes of two groups were collected by retrospective study method,and were compared by independent-samples t test,Mann-Whitney U test,and chi-square test or continuity correction chi-square test or Fisher's exact probability method.This study has been approved by the Medical Ethics Committee of the First Affiliated Hospital of Army Medical University[Approval No.(B)KY2023085].Results ①There were no statistical differences in general clinical data such as age,height,weight and body mass index(BMI)three months before pregnancy between two groups(P＞0.05).②Before intervention,there were no statistical differences between two groups in renal function indicators such as 24 h urine protein quantification and creatinine concentration in the first trimester pregnancy(P＞0.05).After intervention,the 24 h urinary protein quantification of CKD pregnant women in the third trimester pregnancy of study group was significantly lower than that of control group,and the difference was statistically significant(Z=-3.09,P=0.002).③The total incidence of pregnancy complications of study group was 50.0％(20/40),which was significantly lower than that of control group 86.7％(26/30),and the difference was statistically significant(X2=10.23,P=0.001).The incidence of thyroid dysfunction in study group was 5.0％(2/40),which was significantly lower than that of control group 30.0％(9/30),and the difference was statistically significant(X2=6.31,P=0.012).④The total incidence of adverse pregnancy outcomes such as premature birth,induced abortion,and spontaneous abortion in study group was 12.5％(5/40),which was significantly lower than that of control group 43.3％(13/30),and the difference was statistically significant(x2=8.53,P=0.008).⑤The birth weight,gestational age at birth,and Apgar scores at 1,5,and 10 min after birth of newborns delivered by CKD pregnant women in the study group all were significantly higher than those in the control group,and the differences were statistically significant(t=-2.90,P=0.007;t=-2.33,P=0.027;t=-2.37,P=0.027;t=-2.13,P=0.042;t=-2.07,P=0.048).Conclusions Adopting intervention measures of MDT management model during perinatal period for CKD pregnant women can effectively reduce the incidence of perinatal complications,alleviate renal burden,reduce incidence of adverse pregnancy outcomes and premature birth.
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