Pregnancy during hemodialysis: perinatal outcome in our cases

doi:10.1016/j.transproceed.2003.11.002

Transplantation Proceedings

Volume 36, Issue 1, January–February 2004, Pages 53-55

https://doi.org/10.1016/j.transproceed.2003.11.002 Get rights and content

Abstract

The perinatal outcome of patients undergoing chronic hemodialysis has been improved in recent years. In this report we review the treatment and outcome of seven pregnancies in women undergoing chronic hemodialysis before and during pregnancy between 2000 and 2002. The hemodialysis schedule was increased from 4 hours twice weekly to 4 hours four to six times weekly. Hemodialysis was performed using a high-flux dialyzer with volume-controlled ultrafiltration. The patients were followed in close collaboration between the obstetrician and the nephrologist. Monitoring of fetal well-being was started after 24 weeks' gestation, using cardiotocography by a nonstress test twice weekly and by weekly Doppler flow measurements. All patients underwent uterine contraction monitoring immediately after the dialysis. The mean gestational age at delivery was 32 weeks (range, 26 to 36 weeks). The causes of preterm delivery were premature contractions, premature rupture of membranes, preeclampsia, and intrauterine growth restriction. The outcomes were two pregnancies complicated by polyhydramnios and six pregnancies, that resulted in live births, all of whom survived. There was one neonatal death. The mean newborn birthweight was 1400 g (range, 420 to 2640 g) and the 1- and 5-minute Apgar scores ranged from 2/8 and 4/10, respectively one infant at 29-weeks gestation experienced respiratory distress syndrome but did well after 12 days. Cesarean section was performed in four pregnancies. The mothers were discharged on postoperative days 3 to 5. It is well known that the management of pregnant patients undergoing chronic hemodialysis is difficult. However, advances in dialysis, obstetrics, and neonatal care have improved the outcomes.

Section snippets

Materials and methods

The seven pregnancies occurred among women undergoing hemodialysis between 2000 and 2002. We retrospectively investigated the following parameters: maternal background, hemodialysis schedule during pregnancy, predialysis biochemical data, blood pressure control, nature of the underlying renal disease, length of time on dialysis, use of erythropoietin for anemia, obstetric complications (polyhydramnios, intrauterine growth restriction [IUGR], preterm delivery), gestational weeks at delivery,

Results

The seven patients undergoing hemodialysis who received antenatal care during pregnancy are described in Table 1. Cases 2, 3, 4, and 6 became pregnant while on dialysis. Cases 1, 5, and 7 started dialysis during an ongoing pregnancy, beginning at 23, 29, and 30 weeks gestation. The mean age at pregnancy was 25 years (range, 22 to 31 years). Serum urea was maintained below 60 mg/dL and the creatinine less than 6 mg/dL by increasing in the duration and frequency of dialysis. to four to six times

Discussion

The management of pregnant patients undergoing chronic hemodialysis is difficult.5, 10, 11 Frequent perinatal complications include miscarriage, preterm delivery, perinatal and infant death, or other adverse sequelae.9, 12 In 1980, The European Dialysis and Transplant Association reported that among the 115 pregnancies in dialysis patients, only 23% yielded surviving infants.⁸ Since 1980, improvements in care and surveillance by nephrology, obstetrics, and neonatology have led to improved

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Cited by (39)

Pregnancy in a patient with chronic renal disease on hemodialysis: Presentation of a case and a literature review
2015, Dialisis y Trasplante
Presentamos el caso de una paciente embarazada con enfermedad renal crónica en estadio avanzado, que ameritó inicio de terapia sustitutiva de la función renal debido a la uremia y la retención de líquidos, en mal estado general a sus 20 semanas de gestación, referida tardíamente para su atención. Sin embargo, fue posible mejorarle su condición general en todos los aspectos, permitiendo llevarla hasta las 38 semanas con un parto vía abdominal, programada electivamente, con resultados favorables para el recién nacido que superan las estadísticas descritas en este tipo de pacientes. El presente caso se acompaña de una revisión.
The case is presented of a pregnant patient at 20 weeks gestation with chronic renal disease in advanced stage and in poor general condition, which required initiation of renal replacement therapy due to uremia and fluid retention. Although her referral was delayed, it was possible to improve her general condition in all aspects, allowing her to have an electively scheduled abdominal birth at 38 weeks, with favorable results for the newborn that exceeded the statistics described in these patients. This case is presented along with a review of the literature and a critical analysis of the management of these patients.
End-Stage Renal Disease and Pregnancy
2013, Advances in Chronic Kidney Disease
Citation Excerpt :
Detailed information was available for 74 pregnancies with a mean maternal age of 32.7 ± 5.0 years, dialysis time of 22 hours (18-24 hours), and target predialysis urea of less than 59 mg/dL.12 Since 2000, a trend toward an increased number of successful pregnancies has been reported with live births rates ranging from 50% to 87%.15-25 A detailed description of these recent reports can be found in Tables 1 and 2, but most of theses articles did not report conception rates and only a few reported the number of elective or spontaneous first trimester abortions.
Pregnancy in patients with ESRD is rare and remains especially challenging. Because endocrine abnormalities and sexual dysfunction decrease fertility, conception rates have been remarkably low in this patient population. Moreover, when pregnancy does occur, hypertension, preeclampsia, anemia, intrauterine growth restriction, preterm delivery, stillbirth, and other complications can decrease the rate of a successful outcome. However, recent experiences with intensive hemodialysis managed by a multidisciplinary team are encouraging with respect to better overall outcomes for mothers and infants. In this article, we discuss the main causes of decreased fertility in dialysis-dependent women, review outcomes and complications of pregnancy among dialysis patients with a special focus on recent intensive hemodialysis data, and summarize the current best strategy to manage pregnant women on dialysis.
Pregnancy in chronic hemodialysis patients
2011, Journal de Gynecologie Obstetrique et Biologie de la Reproduction
La conception en hémodialyse est un événement rare, et à haut risque materno-fœtal. Le but de notre étude est de décrire les différentes grossesses survenues chez nos patientes hémodialysées et de préciser les facteurs de bon pronostic.
Nous avons recensé toutes les grossesses survenues entre janvier 2000 et juillet 2010, et analysé leurs caractéristiques cliniques et biologiques. L’ajustement des paramètres d’hémodialyse et l’adaptation thérapeutique ont été précisés. Les complications materno-fœtales, l’aboutissement des grossesses et le devenir materno-fœtal ont été rapportés.
Sur un intervalle de dix ans et six mois, parmi 23 patientes en âge de procréer, 14 étaient mariées. Nous avons noté 11 grossesses chez huit patientes, avec une incidence de 7,14 % année, et une prévalence de 71,4 %. L’évolution était marquée par la mort fœtale intra-utéro dans un cas, l’interruption thérapeutique de grossesse dans un second cas et quatre avortements spontanés. Seules cinq grossesses ont abouti. L’âge moyen au moment de la conception était de 34 ans et la durée moyenne de dialyse avant conception était de 76 mois. Le diagnostic de grossesse a été fait en moyenne à 10,4 SA. Le terme moyen était de 33,6 SA et le poids de naissance moyen de 2070 g. Le score d’Apgar à la première minute était de 10/10 chez tous les nouveau-nés. Aucune complication maternelle n’a été retrouvée et sur le plan fœtal ; un cas de retard de croissance intra-utérin (RCIU), et une dilatation pyélo-calicielle avec insuffisance rénale résolutive dans un autre ont été rapportés. À long terme, le développement psychomoteur fœtal était normal.
La fertilité chez les patientes hémodialysées chroniques, en âge de procréer s’est améliorée conjointement à celle de la qualité de la dialyse, avec une augmentation de l’incidence de la grossesse et la proportion des enfants viables. Toutefois, les modalités de traitement ne sont pas clairement établies, à cause de l’absence d’études randomisées et du nombre réduit des grossesses lors des séries. Le traitement de l’anémie par l’érythropoïétine (EPO) et par les transfusions sanguines, et l’amélioration des chiffres de l’urémie par une dialyse intensive chez les femmes en hémodialyse, peut améliorer les résultats en réduisant l’incidence de la prématurité et en augmentant l’âge gestationnel.
La grossesse en hémodialyse est un événement rare, mais désiré et précieux. Son aboutissement nécessite une prise en charge multidisciplinaire, associant le néphrologue pour assurer une bonne dialyse et le gynécologue pour un bon suivi obstétrical.
Pregnancy in hemodialysis patients is a rare event, with a high risk of maternal and fetal morbidity. The aim of our study is to report our experience in management of pregnancies occurred in hemodialysis patients, and clarify the factors of good prognosis.
We identified all pregnancies occurred in patients on hemodialysis between January 2000 and July 2010, and analysed their clinical and biological characteristics. The adjustment parameters of hemodialysis sessions, and treatment adjustments have been specified. The maternal and fetal complications and pregnancy outcome have been reported.
Over a period of 10 years and 6 months, among 23 patients of childbearing age, 14 patients were married. We observed 11 pregnancies in eight patients, with an incidence of 7,14% year, and a prevalence of 71,4%. The evolution was marked by intrauterine fetal death in one case, medical pregnancy termination in a second one and four spontaneous abortions. Only five pregnancies were completed. The average age of conception was 34 years. The average duration of dialysis prior to conception was 76 months. Pregnancy diagnosis was made on average after 10,4 weeks. The mean gestational age at delivery was 33,6 weeks, and the mean newborn weight was 2070 g. Apgar score was of 10/10 in the first minute in all newborns. No maternal complication was found. One case of intrauterine growth restriction and another case of pyelo-caliceal dilatation with resolving renal insufficiency were reported. In the long term, the fetal psychomotor development was normal.
The fertility chronic hemodialysis patients in childbearing age have improved together with the quality of dialysis, with an increased incidence of pregnancy and the proportion of viable children. However, treatment modalities are not clearly established, because of the absence of randomized studies and the small number of pregnancies during the playoffs. Treatment of anemia with erythropoietin and blood transfusions, and the improvement in blood urea by extensive dialysis in women on hemodialysis, may improve outcomes by reducing the incidence of prematurity and increasing gestational age.
Pregnancy in hemodilalysis patient is a rare event, but desired and valuable. Its completion requires a multidisciplinary management involving the nephrologist to ensure adequate dialysis and the gynecologist to ensure good obstetrical monitoring.
Pregnancy and its outcomes in hemodialysis patients in Turkey
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Intensified hemodialysis for complicated pregnancy in a primigravida with advanced maternal age: a case report with literature review focusing on appropriate hemodialysis management during pregnancy
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Renal transplantationPregnancy during hemodialysis: perinatal outcome in our cases

Abstract

Section snippets

Materials and methods

Results

Discussion

Am J Kidney Dis

Am J Kidney Dis

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Baillieres Clin Obstet Gynaecol

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Pregnancy in chronic hemodialysis patients in the kingdom of Saudi Arabia

Am J Kidney Dis

Full term pregnancy and successful delivery in a patient on chronic haemodialysis

Successful pregnancy in a patient undergoing chronic hemodialysis

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Renal transplantation
Pregnancy during hemodialysis: perinatal outcome in our cases