Embarazo en hemodiálisis crónica: experiencia de un hospital universitario

Abstract

Background: Pregnancies in women with end stage renal failure are uncommon. However, correction of anemia and improvement in dialysis techniques increases the rate of successful pregnancies. Aim: To describe a 16 years' experience treating pregnant women on hemodialysis and to analyze maternal-fetal outcomes. Materials and Methods: Observational study of a dialysis center historical cohort in a university hospital, between 2001 and 2016. Results: Thirteen pregnancies were found in 11 women aged 23 to 32 years, 77% on dialysis prior to pregnancy. Residual diuresis was 1,300 575] mL in 24 hrs. The baseline hemoglobin was 9.0 [7.6-9.9] g/dL and 92% of patients did not use contraception. The pre-dialysis blood urea nitrogen was 34 [29][30][31][32][33][34][35][36] mg /dL. An ultrasound to confirm pregnancy was done in all. At 23 [14][15][16][17][18][19][20][21][22][23][24][25] weeks of pregnancy, dialysis hours were increased, reaching 24 [19.5-24.0] hours per week. The most common complications were severe arterial hypertension (54%), severe anemia (46%), polyhydramnios (31%) and severe intrauterine growth retardation (IUGR) (23%). The median time of pregnancy at delivery was 34 [29][30][31][32][33][34] weeks. Neonatal median hospitalization length was 4 days, with 18% of neonatal deaths. Conclusions: Pregnancies in dialysis are no longer exceptional. Despite better maternal and fetal outcomes, morbidity and mortality remains higher than in the normal population, which makes multidisciplinary management essential. (Rev Med Chile 2019; 147: 709-717)

Efficacy and safety of hemodialysis strategies for pregnant women with chronic kidney disease: Systematic review

“…During the selection process, 422 duplicates and 6776 references that did not agree with the research question were eliminated after reading the title and abstract (first phase). After reading the full text of the 12 preselected references, the eligibility of six of them was confirmed, [16][17][18][19][20][21] and six references were excluded for not meeting the eligibility criteria [22][23][24][25][26][27] (Table S2). The flowchart of the study selection process is shown in Figure 1.…”

Pregnancy and delivery in women treated with renal replacement therapy: A literature review

“…Середня неонатальна госпіталізація склала 4 дні. Отже, вагітність під час лікування діалізом більше не є винятком, а збільшення тривалості діалізу з 23 тижня вагітності до 24 год/тиждень дозволяє істотно покращити наслідки для матері і плода [13].…”