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364. Perspectives of pregnancy in women with chronic kidney disease: A National Registry Survey Study
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 13 (2018) S50–S150
identification of very abnormal folate levels of <3 mg/L in both made this the likely diagnosis. They each received folic acid 15 mg daily, parenteral vitamin B12, thiamine and oral iron and made good haematological recoveries. Case 1 received 2 units of blood on her initial presentation but case 2 did not. Discussion: Anaemia in pregnancy is very common and most often due to iron deficiency, which is frequently treated without excluding other causes. Folate requirement increases in pregnancy and deficiency is easily and rapidly treated, and does not necessarily require the administration of blood products. Adequate antenatal correction of vitamin deficiency like this avoids bone marrow suppression and helps minimise poor obstetric outcomes associated with pre-existing anaemia should haemorrhage ensue. doi:10.1016/j.preghy.2018.08.405
363. Characteristics of women with preterm pre-eclampsia enrolled to the PREPARE Trial – Preliminary data Leandro De Oliveira a, Marcos Augusto Bastos Dias b, Arundhathi Jeyabalan c, Beth A. Payne d, Christopher Redman e, Laura Magee f, Lucilla Poston g, Lucy C. Chappell h, Paul Seed h, Peter von Dadelszen h, James M. Roberts c PREPARE group i (a Botucatu São Paulo State University, Borucatu, Brazil, b Fernandes Figueira Institute, Rio de Janeiro, Brazil, c University of Pittsburgh School of Medicine, Pittsburgh, United States, d University of British Columbia, Vancouver, Canada, e University of Oxford, Oxford, f United Kingdom, University of London, London, United g Kingdom , Women’s Health Academic Center, London, United h Kingdom, King’s College London, United Kingdom, i The Netherlands) Introduction: Pre-eclampsia is a major cause of short and longterm morbidity for affected offspring, including injuries from birth asphyxia and iatrogenic prematurity. This is a special problem in Brazil since pre-eclampsia accounts for higher prevalence of preterm births comparing with high-income countries. Objective: To reduce preterm births related to pre-eclampsia. Methodology: This is a multicentre study with a stepped wedge design involving seven tertiary centres in Brazil that will receive an intervention based on risk stratification. All data have been recorded in the CoLab COLLECT Database. Results: Table 1 presents the characteristics of 634 women with preterm pre-eclampsia enrolled to the study between January 2017 and March 2018. Conclusion: The PREPARE study will allow to establish reliable characteristics of women with preterm preeclampsia in Brazil. Data expressed in numbers and percentage unless stated otherwise; BP = Blood Pressure; BMI = Body Mass Index. doi:10.1016/j.preghy.2018.08.406
364. Perspectives of pregnancy in women with chronic kidney disease: A National Registry Survey Study Olivia Snowball a, Kate dr Bramham a, Cath Taylor b (a King’s College Hospital, London, United Kingdom, b University of Surrey, Guildford, United Kingdom) Background: Women with chronic kidney disease (CKD) are at risk of complications in pregnancy. Understanding of the experience of pregnancy for women with chronic kidney disease is limited. Currently, care for many pregnant women with CKD is provided by nephrologists and obstetricians in tertiary centres. This survey will seek to determine care received.
S137
The aim of this questionnaire study is to describe variability in care received by women with CKD during and after pregnancy, and explore the impact of model of care delivery on their experiences of care. Methods: An online questionnaire was developed and sent to women with CKD who had at least one pregnancy and who had consented to be contacted for research from the UK Rare Renal Diseases Registry (RaDaR), Pre-eclampsia Chronic Hypertension rEnal and SLE study (PEACHES) and Pregnancy Adaptation In Renal disease Study (PAIRS). Results: There was a 10% response rate. Most women (90%) were of white ethnicity. Most women had successful pregnancies, however, approximately one in seven women had previously had a fetal or perinatal loss. There were no differences in model of care (joined up or fragmented) according to disease severity. Anxiety for health was similar between women with ‘mild’ and ‘severe’ disease. Fewer women in the fragmented care group found the care by their midwife reassuring. Conclusion: Findings suggest variability in care is not necessarily based on disease severity but geography or hospital resource. Women are more satisfied with ‘joined up’ care, supporting a move to MDT care for women with high risk pregnancies as suggest by NICE. The trend toward lower satisfaction levels with midwives when fragmented care is experienced highlights an area of further research needed, with possibly more training for midwives into CKD pregnancies and more integration of midwives into care for these women. doi:10.1016/j.preghy.2018.08.407
366. Pyrexia in the puerperium as first manifestation of systemic lupus erythematosus Christi Brasted, Jemimah Obaro (Royal Oldham Hospital, Oldham, Greater Manchester, United Kingdom) We report the case of a 29 year-old Asian woman who presented 13 days post-normal vaginal delivery with pyrexia, tachycardia and feeling generally unwell referred to hospital by her general practitioner (GP). She had a background of recurrent urinary tract infections and recently had an uncomplicated vaginal delivery with normal observations immediately post-partum and an uneventful short hospital stay. She was a non-smoker. She was started on oral antibiotics by her GP. She had a septic screen and was commenced on intravenous antibiotics. She developed a cough with clear sputum. Her broad-spectrum antibiotics were changed on microbiology advice and Tamiflu was commenced. She had a multitude of investigations performed including blood tests, blood cultures and swabs, echocardiogram, electrocardiography (ECG), pelvic ultrasound scan, Computed tomography (CT) abdomen/pelvis scan and infectious diseases screen. Despite the antibiotics, her pyrexia persisted. Following review by the respiratory team, an auto-immune screen was performed. This was positive for ANA, SSA-60, chromatin and DsDNA. A diagnosis was made for systemic lupus erythematosus with nephritis as she also developed proteinuria and haematuria. She was then reviewed by a rheumatologist and commenced on corticosteroid treatment. doi:10.1016/j.preghy.2018.08.408
identification of very abnormal folate levels of <3 mg/L in both made this the likely diagnosis. They each received folic acid 15 mg daily, parenteral vitamin B12, thiamine and oral iron and made good haematological recoveries. Case 1 received 2 units of blood on her initial presentation but case 2 did not. Discussion: Anaemia in pregnancy is very common and most often due to iron deficiency, which is frequently treated without excluding other causes. Folate requirement increases in pregnancy and deficiency is easily and rapidly treated, and does not necessarily require the administration of blood products. Adequate antenatal correction of vitamin deficiency like this avoids bone marrow suppression and helps minimise poor obstetric outcomes associated with pre-existing anaemia should haemorrhage ensue. doi:10.1016/j.preghy.2018.08.405
363. Characteristics of women with preterm pre-eclampsia enrolled to the PREPARE Trial – Preliminary data Leandro De Oliveira a, Marcos Augusto Bastos Dias b, Arundhathi Jeyabalan c, Beth A. Payne d, Christopher Redman e, Laura Magee f, Lucilla Poston g, Lucy C. Chappell h, Paul Seed h, Peter von Dadelszen h, James M. Roberts c PREPARE group i (a Botucatu São Paulo State University, Borucatu, Brazil, b Fernandes Figueira Institute, Rio de Janeiro, Brazil, c University of Pittsburgh School of Medicine, Pittsburgh, United States, d University of British Columbia, Vancouver, Canada, e University of Oxford, Oxford, f United Kingdom, University of London, London, United g Kingdom , Women’s Health Academic Center, London, United h Kingdom, King’s College London, United Kingdom, i The Netherlands) Introduction: Pre-eclampsia is a major cause of short and longterm morbidity for affected offspring, including injuries from birth asphyxia and iatrogenic prematurity. This is a special problem in Brazil since pre-eclampsia accounts for higher prevalence of preterm births comparing with high-income countries. Objective: To reduce preterm births related to pre-eclampsia. Methodology: This is a multicentre study with a stepped wedge design involving seven tertiary centres in Brazil that will receive an intervention based on risk stratification. All data have been recorded in the CoLab COLLECT Database. Results: Table 1 presents the characteristics of 634 women with preterm pre-eclampsia enrolled to the study between January 2017 and March 2018. Conclusion: The PREPARE study will allow to establish reliable characteristics of women with preterm preeclampsia in Brazil. Data expressed in numbers and percentage unless stated otherwise; BP = Blood Pressure; BMI = Body Mass Index. doi:10.1016/j.preghy.2018.08.406
364. Perspectives of pregnancy in women with chronic kidney disease: A National Registry Survey Study Olivia Snowball a, Kate dr Bramham a, Cath Taylor b (a King’s College Hospital, London, United Kingdom, b University of Surrey, Guildford, United Kingdom) Background: Women with chronic kidney disease (CKD) are at risk of complications in pregnancy. Understanding of the experience of pregnancy for women with chronic kidney disease is limited. Currently, care for many pregnant women with CKD is provided by nephrologists and obstetricians in tertiary centres. This survey will seek to determine care received.
S137
The aim of this questionnaire study is to describe variability in care received by women with CKD during and after pregnancy, and explore the impact of model of care delivery on their experiences of care. Methods: An online questionnaire was developed and sent to women with CKD who had at least one pregnancy and who had consented to be contacted for research from the UK Rare Renal Diseases Registry (RaDaR), Pre-eclampsia Chronic Hypertension rEnal and SLE study (PEACHES) and Pregnancy Adaptation In Renal disease Study (PAIRS). Results: There was a 10% response rate. Most women (90%) were of white ethnicity. Most women had successful pregnancies, however, approximately one in seven women had previously had a fetal or perinatal loss. There were no differences in model of care (joined up or fragmented) according to disease severity. Anxiety for health was similar between women with ‘mild’ and ‘severe’ disease. Fewer women in the fragmented care group found the care by their midwife reassuring. Conclusion: Findings suggest variability in care is not necessarily based on disease severity but geography or hospital resource. Women are more satisfied with ‘joined up’ care, supporting a move to MDT care for women with high risk pregnancies as suggest by NICE. The trend toward lower satisfaction levels with midwives when fragmented care is experienced highlights an area of further research needed, with possibly more training for midwives into CKD pregnancies and more integration of midwives into care for these women. doi:10.1016/j.preghy.2018.08.407
366. Pyrexia in the puerperium as first manifestation of systemic lupus erythematosus Christi Brasted, Jemimah Obaro (Royal Oldham Hospital, Oldham, Greater Manchester, United Kingdom) We report the case of a 29 year-old Asian woman who presented 13 days post-normal vaginal delivery with pyrexia, tachycardia and feeling generally unwell referred to hospital by her general practitioner (GP). She had a background of recurrent urinary tract infections and recently had an uncomplicated vaginal delivery with normal observations immediately post-partum and an uneventful short hospital stay. She was a non-smoker. She was started on oral antibiotics by her GP. She had a septic screen and was commenced on intravenous antibiotics. She developed a cough with clear sputum. Her broad-spectrum antibiotics were changed on microbiology advice and Tamiflu was commenced. She had a multitude of investigations performed including blood tests, blood cultures and swabs, echocardiogram, electrocardiography (ECG), pelvic ultrasound scan, Computed tomography (CT) abdomen/pelvis scan and infectious diseases screen. Despite the antibiotics, her pyrexia persisted. Following review by the respiratory team, an auto-immune screen was performed. This was positive for ANA, SSA-60, chromatin and DsDNA. A diagnosis was made for systemic lupus erythematosus with nephritis as she also developed proteinuria and haematuria. She was then reviewed by a rheumatologist and commenced on corticosteroid treatment. doi:10.1016/j.preghy.2018.08.408