1996 Volume 29 Issue 7 Pages 1171-1176
We report the successful management of pregnancy and delivery in a woman requiring chronic hemodialysis. A 37-year-old woman with a history of chronic hemodialysis for 12 years was admitted with threatened abortion at the 9th week of pregnancy. In order to avoid complications such as intrauterine growth retardation, we attempted to establish a schedule of hemodialysis and a proper dry weight. The dialysis frequency was increased to six times per week to keep the blood urea nitrogen level under 50mg/dl and serum creatinine under 7mg/dl. The left atrial dimension was measured by ultrasonic echocardiography and was standardized using the body mass index (LAD/BMI). Alpha human natriuretic peptide (HANP) and the circumference and skin fold thickness of the upper arm were measured to set the appropriate dry weight. Meetings were held regularly among the hemodialysis unit staff, departments of gynecology and pediatrics. Although seemingly adequate hemodialysis and an appropriate dry weight were set, polyhydramnions and IUGR developed at the 20th week of pregnancy. At the 31st week of pregnancy arterial blood pressure rose and generalized edema appeared. The patient underwent cesarean section giving birth to a baby girl weighing 1484g.
It is difficult to set an appropriate dry weight for a pregnant woman on chronic hemodialysis because the pregnancy is occasionally associated with polyhydroamnios, changes in body fat mass, IUGR and toxemia.
We conclude that setting an appropriate dry weight, by measuring LAD/BMI, HANP and body fat mass, is essential for maintaining pregnancy in women requiring chronic hemodialysis.
