Contraception in chronic kidney disease: a best practice position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology.
Contraception in chronic kidney disease: a best practice position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology.
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DOI：
10.1007/s40620-020-00717-0
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发表时间：
2020-12
影响因子：
3.4
通讯作者：
Piccoli GB
中科院分区：
文献类型：
--
作者：
Attini R;Cabiddu G;Montersino B;Gammaro L;Gernone G;Moroni G;Santoro D;Spotti D;Masturzo B;Gazzani IB;Menato G;Donvito V;Paoletti AM;Piccoli GB
尽管生育率降低，但CKD的所有阶段都有可能受孕和分娩。虽然成功的计划怀孕正在增加，但意外怀孕可能会产生长期的有害影响，因此节育的重要性，这一问题在临床实践中经常被忽视。这份立场声明中总结的证据主要来自总体人口或其他患者类别，缺乏专门针对CKD的指南。雌孕药可用于早期非蛋白尿型CKD，但不包括系统性红斑狼疮和免疫紊乱，具有血栓栓塞症和高血压的高风险。相反，黄体酮通常是安全的，其主要副作用是月经期间出现斑点。非药物宫内节育器是一个很好的选择；需要仔细评估盆腔感染高危患者是否使用非药物宫内节育器，尽管风险程度仍然存在争议。屏障方法在正确使用时相对有效，风险很小，避孕套是唯一可以防止性传播疾病的避孕措施。手术绝育也很少使用，因为手术涉及的风险；它不是绝对的禁忌，可以在特定的情况下考虑。使用大剂量孕激素或宫内节育器的紧急避孕不是禁忌，但应尽可能避免，即使远比堕胎更可取。手术流产是侵入性的，但CKD的药物流产经验仍然有限，特别是在疾病的晚期。总之，个性化避孕是可行的、安全的，应该向所有不想怀孕的育龄CKD妇女提供。
Even though fertility is reduced, conception and delivery are possible in all stages of CKD. While successful planned pregnancies are increasing, an unwanted pregnancy may have long-lasting deleterious effects, hence the importance of birth control, an issue often disregarded in clinical practice. The evidence summarized in this position statement is mainly derived from the overall population, or other patient categories, in the lack of guidelines specifically addressed to CKD. Oestroprogestagents can be used in early, non-proteinuric CKD, excluding SLE and immunologic disorders, at high risk of thromboembolism and hypertension. Conversely, progestin only is generally safe and its main side effect is intramestrual spotting. Non-medicated intrauterine devices are a good alternative; their use needs to be carefully evaluated in patients at a high risk of pelvic infection, even though the degree of risk remains controversial. Barrier methods, relatively efficacious when correctly used, have few risks, and condoms are the only contraceptives that protect against sexually transmitted diseases. Surgical sterilization is rarely used also because of the risks surgery involves; it is not definitely contraindicated, and may be considered in selected cases. Emergency contraception with high-dose progestins or intrauterine devices is not contraindicated but should be avoided whenever possible, even if far preferable to abortion. Surgical abortion is invasive, but experience with medical abortion in CKD is still limited, especially in the late stages of the disease. In summary, personalized contraception is feasible, safe and should be offered to all CKD women of childbearing age who do not want to get pregnant.
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影响因子：
168.9
作者：
Beral, V.;Doll, R.;Risch, H. A.
通讯作者：
Risch, H. A.
影响因子：
6.1
作者：
Bahamondes, Luis;Brache, Vivian;Landoulsi, Sihem
通讯作者：
Landoulsi, Sihem
影响因子：
3.4
作者：
Cabiddu, Gianfranca;Castellino, Santina;Piccoli, Giorgina Barbara
通讯作者：
Piccoli, Giorgina Barbara
影响因子：
27.4
作者：
Andreoli L;Bertsias GK;Agmon-Levin N;Brown S;Cervera R;Costedoat-Chalumeau N;Doria A;Fischer-Betz R;Forger F;Moraes-Fontes MF;Khamashta M;King J;Lojacono A;Marchiori F;Meroni PL;Mosca M;Motta M;Ostensen M;Pamfil C;Raio L;Schneider M;Svenungsson E;Tektonidou M;Yavuz S;Boumpas D;Tincani A
通讯作者：
Tincani A
影响因子：
0.8
作者：
Amat, L.;Bulach, A.;Scheffler, M.
通讯作者：
Scheffler, M.