Management of the Pregnant Chronic Dialysis Patient

Reddy, Sai Subhodhini; Holley, Jean Lake

doi:10.1053/j.ackd.2007.01.005

Cited by 69 publications

(89 citation statements)

References 56 publications

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“…End-stage organ disease disrupts normal gonadal function; consequently, pregnancies in patients with end-stage disease are still relatively uncommon (1). Fertility is improved within months after the successful replacement of an infirmed organ (2); therefore, it is not surprising that increasing numbers of pregnancies are reported in patients with transplanted kidneys, liver, heart, lungs, and small bowel and even in those with multiple organ transplants.…”

mentioning

confidence: 99%

Pregnancy after Kidney Transplantation

McKay

Josephson²

2008

Clinical Journal of the American Society of Nephrology

128

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Reproductive success is a common, expected outcome for male and female recipients of solid-organ transplants. Men can father children, and women can become pregnant and carry the fetus to delivery. There are, however, important maternal and fetal complications that need to be considered to provide optimal care to the mother and her infant. Although pregnancy is common after the transplantation of all solid organs, guidelines for optimal counseling and clinical management are limited. This review discusses information to help the physician counsel the kidney transplant recipient about risks of pregnancy for the mother and the fetus and provides information to help guide treatment of the pregnant transplant recipient.

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mentioning

confidence: 99%

Pregnancy after Kidney Transplantation

McKay

Josephson²

2008

Clinical Journal of the American Society of Nephrology

128

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“…A recent report by Smith and colleagues highlighted the utility of intensifying the peritoneal dialysis prescription to include 24-h continuous cycler peritoneal dialysis during the third trimester [6], and in the current issue, Tuot et al [7] present an interesting case of nutritional support provided to a pregnant woman on hemodialysis with hyperemesis gravidarum using intradialytic parenteral nutrition (IDPN). The latter two reports underscore the need for increased dialysis dose to mitigate the deleterious effects of the uremic milieu on the developing fetus, a practice that is in agreement with expert opinion [8][9][10]. Indeed, a recent retrospective study of 28% women receiving hemodialysis found that birth weight C1,500 g and a gestational age C32 weeks correlated with maternal blood urea nitrogen levels of \49 and\48 mg/dL, respectively (18 and 17 mmol/L) [4].…”

mentioning

confidence: 66%

Intensifying renal replacement therapy during pregnancy: the role for nocturnal home hemodialysis

Craig

Podymow

2009

Int Urol Nephrol

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“…Prematurity, either resulting from preterm labor or anticipated resolution due to maternal indications, is the major cause of neonatal morbidity and mortality 10,15 . In our study, 49.2% of women had pre-term labor, and 71.5% (10/14) delivered under 37 complete weeks of gestation, however only 4 of 14 had it in 34 weeks of gestation.…”

Section: Discussionmentioning

confidence: 99%

“…Another risk of dialysis during pregnancy is the common occurrence of maternal hypotension throughout the procedure, which can cause poor placental perfusion and fetal distress 3 . Other fetal complications are: congenital anomalies (tetralogy of Fallot, genital changes), low birth weight (LBW), fetal growth restriction (FGR), polyhydramnios, prematurity (present in 84% of the cases) 9,10 , electrolyte disturbance (hypocalcemia) due to osmotic diuresis 5 , and neonatal deaths 9,10 .…”

Section: Introductionmentioning

confidence: 99%

“…Among the most significant maternofetal complications in women with CKD, there are the following: hypertension and preeclampsia (occurring in 80% of the cases) 5,7,9 , anemia (with the need of blood transfusion), peritoneal infection, placental insufficiency, preterm labor, and stillbirth 9,10 . Another risk of dialysis during pregnancy is the common occurrence of maternal hypotension throughout the procedure, which can cause poor placental perfusion and fetal distress 3 .…”

Section: Introductionmentioning

confidence: 99%

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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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Management of the Pregnant Chronic Dialysis Patient

Cited by 69 publications

References 56 publications

Pregnancy after Kidney Transplantation

Pregnancy after Kidney Transplantation

Intensifying renal replacement therapy during pregnancy: the role for nocturnal home hemodialysis

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

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