Abstract
In recent years, thanks to rapid advances in hemodialysis and improvement in the quality of life due to recombinant human erythropoietin, reports have occasionally been published regarding successful delivery by patients on hemodialysis. During a 6-year period, we have encountered 2 pregnancies in patients on chronic hemodialysis and 1 pregnancy in a nondialysis patient with chronic renal failure (CRF). In the present study, we investigated factors influencing the course of pregnancy in patients with CRF. In case 1 the patient was a 23-year-old woman who had been on hemodialysis for 7 years. She was admitted to our hospital with eclampsia and hypertension in the 20th week of pregnancy and was delivered of a female infant weighing 870g by Cesarean section at the 34th week. The infant's Apgar score was 8-10 and no abnormalities or malformations were noted. The patient in case 2 was a 24-year-old woman who had been on hemodialysis for 1.5 years. Although hypertension developed in late pregnancy, vaginal delivery of a male infant weighing 2856g was achieved at the 39th week. The infant's Apgar score was 9-10 and no malformations other than craniostenosis were noted. In case 3 the patient was a 38-year-old woman who was admitted to our hospital with CRF (Cr 4.2mg/dl, BUN 54mg/dl, 24-hr Ccr 17.6ml/min), hypertension, and anemia. A female infant weighing 2202g was delivered by Cesaream section in the 39th week of pregnancy. The infant's Apgar score was 9-10 and no abnormalities or malformations were noted. Since various reports have been published regarding the complications of delivery in patients with CRF, careful monitoring of such patients is needed not only at delivery but also during pregnancy. It appears particularly important to use dietary therapy and frequent hemodialysis to keep BUN levels under 60mg/dl, and to control anemia (Ht>30%) and hypertension. It also seems necessary to promote planned pregnancy and delivery so that potential problems and malformations can be avoided.
