Pregnancy in a hemodialysis patient with an ethical/cultural challenge

Each year, one in 200 women of child-bearing age conceive while on dialysis. Of those pregnancies not electively terminated, 46% result in a surviving infant. Late pregnancy losses are common with 25% ending in second trimester spontaneous abortion, stillbirth or neonatal death (Hou & Firanek, 1998). Despite these alarming statistics, there has been an increase in the number of successful pregnancies reported in the literature (Bagon et al., 1998; Romao et al., 1998). This case study presentation will allow readers to appreciate both clinical challenges and ethical issues associated with a pregnant, hemodialysis-dependent woman. Despite being given information about the risks of pregnancy while on dialysis, Mrs. T. was determined to have a second child (she has a two-year-old son). Her strong religious beliefs led her to believe that Allah would protect her and her child from harm. This created an ethical conflict with many members of the interdisciplinary health care team, who were of the opinion that a pregnancy would be detrimental to Mrs. T's health. Five months after initiation of hemodialysis, Mrs. T. did become pregnant. The unique nature of an Arabic-speaking Muslim woman who was pregnant and on dialysis provided an opportunity for the health care team to become more familiar with cultural and ethical issues that impacted greatly on her care. At 36 weeks, Mrs. T. delivered a healthy 2362 gram (5.1 lb.) baby girl with an apgar score of four and eight.