Embarazos exitosos en hemodiálisis crónica: experiencia de un único centro

Espinoza, Francisco; Romeo, Romina; Ursu, Marcela; Tapia, Augusto; Vukusich, Antonio

doi:10.4067/s0034-98872013000800006

Cited by 11 publications

(15 citation statements)

References 15 publications

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“…Se logró precisar la causa de la enfermedad renal crónica en 92% de las pacientes (12 casos): 6 con glomerulopatía crónica (46,1%), 2 pielonefritis crónica (15,3%), 2 nefropatía lúpica (15,3%), 1 glomerulonefritis focal y segmentaria (7,6%) y 1 glomerulonefritis mesangiocapilar (7,6%). El 76,9% de las pacientes se encontraban en diálisis previo al embarazo, con un tiempo de permanencia de 4 meses y un esquema dialítico de 10,5 [10,[5][6][7][8][9][10][11][12],0] horas semanales. Sólo una de las pacientes se encontraba en peritoneodiálisis al momento de embarazo, cambiándose a hemodiálisis durante el segundo trimestre.…”

Section: Resultsunclassified

“…Sólo una de las pacientes se encontraba en peritoneodiálisis al momento de embarazo, cambiándose a hemodiálisis durante el segundo trimestre. La diuresis residual fue de 1.300 [625-1.575] mL en 24 h. La hemoglobina previa al embarazo fue de 9 [7,[6][7][8][9]9] g/dL.…”

Section: Resultsunclassified

“…De las tres pacientes que iniciaron diálisis durante el embarazo (23%), el inicio de ésta fue a las 22 [15][16][17][18][19][20][21][22][23][24] semanas. El incremento en el número de horas de diálisis se efectuó a las 23 [14][15][16][17][18][19][20][21][22][23][24][25] semanas de gestación, alcanzando 24 [19,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] horas semanales. La terapia de reemplazo renal se realizó principalmente en forma ambulatoria (84%), sin embargo, hubo 3 casos en los que se requirió hospitalizar transitoriamente por complicaciones, las que se describen en la Tabla 3.…”

Section: Adecuación En Diálisisunclassified

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Embarazo en hemodiálisis crónica: experiencia de un hospital universitario

2019

Rev. méd. Chile

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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)

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Section: Resultsunclassified

Section: Adecuación En Diálisisunclassified

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Embarazo en hemodiálisis crónica: experiencia de un hospital universitario

2019

Rev. méd. Chile

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“…In that series, it occurred in 64.3% of women, better than the 100% reported in the Chilean cohort 16 . Cesarean indications were previous C-section in 3 of them, abruption placenta in 2, fetal distress in 2 and clinical maternal condition in 2.…”

Section: Discussionmentioning

confidence: 95%

“…This is a serious complication of pregnancy, however it did not occur in any of the cases followed in our institution. One case of oligohydramnios, other of polyhydramnios and 1 intrauterine growth restriction were also recorded 16 .…”

Section: Discussionmentioning

confidence: 99%

Pregnancy in women undergoing hemodialysis: case series in a Southeast Brazilian reference center

Suarez¹,

Costa²,

Parpinelli³

et al. 2015

Rev. Bras. Ginecol. Obstet.

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PURPOSE: To describe maternal and neonatal outcomes in pregnant women undergoing hemodialysis in a referral center in Brazilian Southeast side. METHODS: Retrospective and descriptive study, with chart review of all pregnancies undergoing hemodialysis that were followed-up at an outpatient clinic of high-risk prenatal care in Southeast Brazil. RESULTS: Among the 16 women identified, 2 were excluded due to follow-up loss. In 14 women described, hypertension was the most frequent cause of chronic renal failure (half of cases). The majority (71.4%) had performed hemodialysis treatment for more than one year and all of them underwent 5 to 6 hemodialysis sessions per week. Eleven participants had chronic hypertension, 1 of which was also diabetic, and 6 of them were smokers. Regarding pregnancy complications, 1 of the hypertensive women developed malignant hypertension (with fetal growth restriction and preterm delivery at 29 weeks), 2 had acute pulmonary edema and 2 had abruption placenta. The mode of delivery was cesarean section in 9 women (64.3%). All neonates had Apgar score at five minutes above 7. CONCLUSIONS: To improve perinatal and maternal outcomes of women undergoing hemodialysis, it is important to ensure multidisciplinary approach in referral center, strict control of serum urea, hemoglobin and maternal blood pressure, as well as close monitoring of fetal well-being and maternal morbidities. Another important strategy is suitable guidance for contraception in these women. ResumoOBJETIVOS: Descrever os resultados maternos e neonatais de mulheres grávidas que estavam em tratamento de hemodiálise em um centro de referência no Sudeste brasileiro. MÉTODOS: Estudo retrospectivo e descritivo, com revisão de prontuários de todas as gestações em hemodiálise, acompanhadas no pré-natal especializado da região Sudeste do Brasil. RESULTADOS: Entre as 16 mulheres identificadas, 2 foram excluídas devido à perda de seguimento. Das 14 descritas, a hipertensão foi a causa mais frequente de insuficiência renal crônica (50% dos casos). A maioria (71,4%) realizava tratamento de hemodiálise há mais de um ano e todas elas foram submetidas a 5 ou 6 sessões por semana. Onze mulheres tinham hipertensão crônica, 1 das quais também era diabética, e 6 eram fumantes. Em relação às complicações da gravidez, 1 das mulheres hipertensas desenvolveu hipertensão maligna (com restrição de crescimento fetal e parto prematuro com 29 semanas), 2 tiveram edema pulmonar agudo e 2 apresentaram descolamento prematuro de placenta. O tipo de parto foi cesariana em 9 mulheres (64,3%). Todos os recém-nascidos tiveram Apgar aos cinco minutos maior que 7. CONCLUSÕES: Para melhorar os resultados perinatais e maternos de mulheres em hemodiálise, é importante ter uma abordagem multidisciplinar em centro de referência, um controle rigoroso da uremia, hemoglobina e pressão arterial materna, bem como acompanhar de perto o bem-estar fetal e a morbidade materna. Outra estratégia importante é a orientação adequada para contracepção nessas mulheres.Obste...

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Best practices on pregnancy on dialysis: the Italian Study Group on Kidney and Pregnancy

Cabiddu

Castellino²,

Gernone

et al. 2015

J Nephrol

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Timing of dialysis start is not clear, considering also the different support therapies; successful pregnancy is possible in both PD and HD; high efficiency and strict integration with residual kidney function are pivotal in both treatments, the blood urea nitrogen test being perhaps a useful marker in this context. To date, long-hour HD has provided the best results. Strict, personalized obstetric surveillance is warranted; therapies should be aimed at avoiding vitamin B12, folate and iron deficits, and at correcting anaemia; vitamin D and calcium administration is safe and recommended. Women on dialysis should be advised that pregnancy is possible, albeit rare, with both types of dialysis treatment, and that a success rate of over 75% may be achieved. High dialysis efficiency and frequent controls are needed to optimize outcomes.

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Embarazos exitosos en hemodiálisis crónica: experiencia de un único centro

Abstract: Background: The frequency of pregnancies during dialysis is increasing. This condition requires changes in the dialysis (Rev Med Chile 2013; 141: 1003-1009.

Cited by 11 publications

References 15 publications

Embarazo en hemodiálisis crónica: experiencia de un hospital universitario

Embarazo en hemodiálisis crónica: experiencia de un hospital universitario

Pregnancy in women undergoing hemodialysis: case series in a Southeast Brazilian reference center

Best practices on pregnancy on dialysis: the Italian Study Group on Kidney and Pregnancy

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