Abstract
Pregnancy and delivery have been considered contraindicated in patients with maintenance HD because of both high maternal and fetal risks, though pregnancies were rare in such patients. However, recent remarkable progress in HD techniques as well as good control of patients with maintenance HD has made pregnancy and delivery successful. At least 12 such cases have been reported in Japan upto now. This report describes a case of successful delivery.
The patient, 32 years old, with a 7 year history of maintenence HD became pregnant and came under our care 14 weeks later. Throughout her pregnancy BUN and S-Cr were set to be controlled below 60mg/dl and 6mg/dl, respectively. Dry weight was determined by estimating the volume of amniotic fluid and fetal weight. Systolic BP was controlled so as to maintain it at a level of no less than 100mmHg during each dialysis. HD was performed using low dose heparinization.
At 32-weeks and 2-days of pregnancy she delivered a girl by Caesarean section. Her Apgar score was 9 point and her general condition was good, except for a body weight (BW) of 1454 gr. The baby was cared for at NICU and was able to be discharged with a BW of 3310 gr 60 days after birth. Four months after delivery BW had increased to 5450 gr and no abnormalities have been observed. The mother returned to regular HD immediately after delivery and has been well controlled since then.
The factors contributing to success in this patient are believed to be as follows, 1. excellent self-control, 2. cooperation of the family, 3. cooperation of the nephrologist, gynecologist and pediatrician in caring for both mother and baby. 4. Good HD control (BUN<60mg/dl, S-Cr<6mg/dl and Ht>30%) during pregnancy. Another factor contributing to success was the fact that the patient was able to continue pregnancy for more than 30 weeks and that the baby was able to grow over 1000 gr.
We feel that patients undergoing maintenance HD who want to have a baby should been informed that pregnancy and delivery in patients on maintenance HD are not always safe and require great effort on the part of the patient herself as well as her family and the medical staff.
