Pregnancy in hemodialysis patients

Pregnancy is an infrequent event in women at child bearing age who are on chronic dialysis therapy. To evaluate the incidence and the various therapeutic interventions on the outcome of pregnancy we studied 80 women on chronic hemodialysis. There were six pregnancies in five patients over six years of follow up (1988 -1994). To reduce the risk factors associated with pregnancy, we tried to control the blood pressure to a level below l50/90mmHg, to increase the duration and frequency of hemodialysis, to keep the hemoglobin level in the blood above 80 gm/L and to minimize the risk of bleeding by the usage of regional heparinization during the dialysis sessions. Also we kept predialysis BUN below 25mmol/L and used bicarbonate based dialysate. Two pregnancies ended with spontaneous abortion, three with premature delivery and only one had delivery on time. Two of the infants born alive died later during the neonatal period, while the other two are still alive - one, a girl, is now 5 years old and the other, a boy, is now 1 (1/2) years old. None of our pregnant women died. We conclude that pregnancy is of low incidence in hemodialysis patients, and is mostly unsuccessful. However, the modern advances in hemodialysis therapy, the wide choice of anti-hypertensive, the correction of anemia, and the improvement in the general health of HD patients may improve the outcome.