Pregnancy On Chronic Dialysis Patients: A Case Series
Keywords:
pregnancy, women, child, chronic kidney disease, renal failure, dialysis, hemodialysis, hypertension, universal health coverage.Abstract
Background: Pregnancy in patients with chronic dialysis is uncommon due to various factors, one of it is the increasing incidence of CKD among women in reproductive age. Even if pregnancy occurs, the risks and complications that may arise during pregnancy present a challenge in managing the patient. Risks to the child such as congenital abnormalities, premature birth, low birth weight, and even fetal death can still occur if the mother's kidney failure management is not optimally provided.
Case illustration: Two patients who had been undergoing hemodialysis for about 2.5 years, discovered their pregnancy after the second trimester. Subsequently, the patient underwent dialysis for 15 hours/week, received PRC transfusions, erythropoietin injections, antihypertensive medications, and multivitamins. The babies were being delivered via cesarean section (C-section) with a birth weight of 1600 and 1800 g. The patients were discharged within the first week post-C-section without complications and continued dialysis twice a week, while the baby was admitted to the NICU for stabilization.
Discussion: Many literatures recommended increased hemodialysis sessions up to 20 hours per week during pregnancy to improve maternal and fetal outcome. With limited resources in our center and our universal health insurance, we can only give these patients 15 hours of dialysis per week. Nevertheless, we can maintain BUN below 50 and SBP about 140-150 mmHg. The problem in this patient was the Hb level that keep decreasing despite ESA injection, supplement, and PRC transfusion. The baby of the second patient was having CTEV, small secundum ASD, mild TR, and hypoganglionosis. She discharged after about one month admitted in the NICU.
Conclusion: Even with recent advances in CKD management resulting in increased prevalence of pregnancy, it still a relatively high-risk event. Provision of multidisciplinary team along with good quality of universal health coverage are necessary to manage these cases.
