Preeclampsia (PE) is a major cause of maternal and fetal mortality, and preterm birth. Previous studies indicate that lipid-apheresis may prolong pregnancy, namely heparin-mediated extracorporeal LDL-precipitation (HELP)- and dextran sulfate cellulose (DSC)-apheresis. We now report on double membrane plasmapheresis (DFPP) in early-onset preeclampsia (eoPE). Open pilot study assessing the prolongation of pregnancy in PE by lipoprotein-apheresis (DRKS00004527). Two women with eoPE were treated by DFPP and compared to a historical cohort of 6 patients with eoPE treated by HELP-apheresis (NCT01967355). Clinical outcome of mothers and babies and prolongation of pregnancies (time of admission to birth). Patient 1 (33y; 22 + 5/7GW) received 4 DFPP. Delivery day 19; birthweight 270 g; weight at discharge 2134 g on day 132. Patient 2 (35y; 21 + 4/7GW) received 2 DFPP. Delivery day 19; birthweight 465 g; weight at discharge 2540 g on day 104. DFPP was well tolerated by both patients. DFPP proved to be save and pregnancies remained stable as long as 19 days. Although babies were born very preterm both babies could finally be dismissed from hospital. No relevant clinical differences between DFPP and HELP-apheresis could be observed. Therefore, DFPP may extend the range of available apheresis techniques to prolong pregnancies in early-onset preeclampsia. However, further studies are necessary to gain more information. REGISTER: (DRKS00004527).

Purpose: The aim of the present study was to quantify the rate of thromboembolic events (TE) in pregnant women with SARS-CoV-2 infection and to characterize risk factors to provide a basis for individualized recommendation on prophylactic measures. Methods: CRONOS is a multicenter, prospective observational study conducted in Germany and Austria during the COVID-19 pandemic. Pregnant women with confirmed SARS-CoV-2 infection were enrolled. Data on demographics, medical history, COVID-19-related aspects, and pregnancy and birth outcomes were collected. TE was particularly queried and used as the primary outcome. A combination of “TE,” “maternal or fetal death,” or “severe postpartum hemorrhage” was defined as a secondary endpoint. Risk analyses were performed using univariate and multivariable logistic regression models. Results: Data from 8033 pregnant patients showed 40 TEs (0.5% incidence). TE rates were 10% in ICU patients, 0.2–0.4% in those with moderate-to-mild COVID-19, and < 0.1% in asymptomatic women. Pulmonary embolism occurred in 21 cases, deep vein thrombosis in 12, and 7 had atypical or arterial TE. Risk factors included advanced gestational age, COVID-19 symptoms, hospitalization or ICU admission, premature birth, cesarean section, delivery within 4 weeks of infection, higher weight gain, anemia, and chronic inflammatory bowel disease. COVID-19 vaccination reduced risk. The logistic risk model yielded an AUC of 0.87 (95% CI 0.81–0.94). Conclusion: The TE rate in pregnant women is largely determined by the severity of the disease. In asymptomatic or mild cases, other factors outweigh TE risk, while severe COVID-19 requiring ICU admission poses a high TE risk despite prophylaxis.

Anamnese und klinischer Befund Wir berichten über drei Schwangere: zwei in verschiedenen Stadien der Niereninsuffizienz und eine Nierentransplantierte. Pat. 1 ist eine 32-Jährige I/0 in der 20. SSW mit akutem Nierenversagen, nephrotischem Syndrom und familiärem Mittelmeerfieber in der Anamnese. Pat. 2 ist eine 23-Jährige mit Schrumpfnieren bds. und Niereninsuffizienz Stad. V unter Dialyse 3 × wöchentlich, die Schwangerschaft war eine Zufallsdiagnose. Pat. 3 ist eine 29-Jährige im Z. n. Nierentransplantation vor mehreren Jahren. Diagnose, Therapie und Verlauf Bei Pat. 1 wurde die Verdachtsdiagnose einer AA-Amyloidose durch Nierenbiopsie bestätigt. Im Verlauf wurde sie zunehmend dialysepflichtig. Bei Pat. 2 musste die Dialyse ebenfalls eskaliert werden. Beide Schwangerschaften wurden vorzeitig beendet. Die transplantierte Pat. 3 wurde am Termin ohne Komplikationen im Verlauf entbunden. Folgerung Die Verbesserung des fetalen Outcomes ist v. a. auf die interdisziplinäre Zusammenarbeit zurückzuführen. Ziel sollte sein, junge nierenkranke Frauen bereits vor einer Schwangerschaft umfassend über Risiken und Erfolgsaussichten zu beraten und zu betreuen. History and clinical findings We report of three pregnancies, two with renal insufficiency and one with a history of renal transplantation. Pat.1 is a 32y at 20 weeks of gestation with acute renal failure, nephrotic syndrome and history of familial Mediterranean fever. Case 2 is a 23y with cirrhotic kidneys, stage 5 of chronic kidney disease and dialysis treatment 3 × a week. The pregnancy was an incidental finding. Pat. 3 is a 29y I/0 with history of renal transplantation years ago. Diagnosis, treatment and course In pat. 1a renal biopsy confirmed the suspected diagnosis of AA amyloidosis. Due to deterioration of the kidney function, she required dialysis up to 6 × a week. In Case 2 the dialysis increased to 6 × a week as well. In both patients, we indicated delivery at 35 weeks of gestational age. Pat. 3 delivered at term without complications. Conclusion A close interdisciplinary cooperation improves neonatal outcome in pregnant women with CKD. Counseling and risk assessment of these patients should be initiated before pregnancy. The care of these high-risk pregnancies needs to be performed at a tertiary care center with the above-mentioned specialists.