A maternal medicine perspective on nephrology

Chronic kidney disease increases the risk of hypertensive disease in pregnancy and superimposed preeclampsia, Prof Nóirín Russell, Consultant Obstetrician and Gynaecologist, HSE Clinical Director of CervicalCheck, and Honorary Clinical Professor at University College Cork, told delegates at the Irish Nephrology Society Winter Meeting 2026.

In her presentation titled ‘Obstetric nephrology – a maternal medicine perspective’, Prof Russell began by emphasising the importance of “real teamwork” versus so-called “co-active group membership”.

“Real teams have shared objectives, structured inter-dependence, where we care what each other thinks, and reflexivity – being able to move and think and change,” Prof Russell outlined.

She discussed the origins of antenatal care and noted how the first Caesarean section on the British Isles where both the mother and baby survived was in 1826.

“As recently as 200 years ago when a C-section was performed either the mum or baby was going to die. That is quite a striking consideration,” Prof Russell stated.

On the matter of stillbirth, when reviews of these cases are undertaken, Prof Russell said that in many cases “there was a failure to identify risk factors such as growth restriction or reduction of foetal movements”.

“There is lots of evidence to show that being small as a foetus is really risky… if you’re a small foetus and nobody knows that you’re small, your risk of stillbirth is 20 per thousand. That’s a sobering statistic.”

She noted the concept of “professional fatalism” around stillbirth and argued that the belief that stillbirth cannot be predicted or prevented “needs to be eradicated”.

She maintained that if investigations are undertaken, “we will find a cause.”

The annual number of stillbirths in Ireland, Prof Russell said, is between 190 and 220.

Risk assessment in obstetrics is critical, she stressed. Prof Russell outlined that pregnant women are categorised into three groups: Those requiring supported care; assisted care; and specialist care at their first maternity visit.

She argued, however, that many women placed into supported and assisted care groups have “far more risk”.

Prof Russell advised that “aspirin is a phenomenal medication that reduces the risk of adverse outcomes in pregnancy” and should be taken by those at risk of adverse outcomes.

“What is risky for nephrologists is that obstetricians are not always as au fait as we should be with defining and diagnosing preeclampsia. That’s the risk to the phone call that comes to try and persuade you that the patient has some strange, weird, and wonderful kidney disease. But actually [while] the kidney disease won’t kill her… the preeclampsia might.”

Prof Russell stressed the importance of “informed choice” and greater education for women around the risks associated with pregnancy.

During a question and answer session following the presentation, the concerning rise of “free birthing” – birthing in the community without antenatal and medical care – was raised.

“It is absolutely terrifying for me as an obstetrician to note this… that’s the space we’re working in as obstetricians at the moment and we have to reflect on why that is,” Prof Russell stated.