Case Report: Delivering A Full-Term Baby While On Hemodialysis Is Possible

Main Category: Urology / Nephrology
Also Included In: Pregnancy / Obstetrics;  Pediatrics / Children's Health
Article Date: 07 Sep 2008 - 0:00 PDT

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For women with chronic kidney disease (CKD), getting pregnant is very rare, and a successful pregnancy is even more uncommon, especially for women on dialysis.

In the July-August 2008 issue of Nephrology Nursing Journal, Mary Coyle and co-authors present a case report of a 35-year-old woman with Stage 5 CKD who successfully completed a 39-week pregnancy while on hemodialysis. The pregnancy was diagnosed at seven weeks, and five three-hour hemodialysis sessions per week were started right away, say the authors.

A care team was assigned to the patient and her family, which included a nephrologist, a dialysis center nurse practitioner, a nurse manager, a dietician, a social worker, and a core group of nurses who would dialyze her. This group, say the authors, was crucial in monitoring signs and symptoms and maintaining a continuum of care. The care team used recommendations in the available literature to manage blood urea nitrogen levels, fluid removal by ultrafiltration and other issues.

The nurse practitioner also shared status updates with the perinatologist and perinatal center nurse practitioner throughout the pregnancy. The perinatologist saw the patient every two weeks and with greater frequency when she reached 24 weeks.

The patient's anemia worsened during the pregnancy, and she also developed hypertension, pre-eclampsia and polyhydramnios, all common among women on dialysis. Despite these complications, fetal heart rate testing and OB ultrasounds revealed an active, growing fetus. A scheduled cesarean section took place at 39 weeks, and the patient delivered a five-pound, seven-ounce daughter. Mother and baby were discharged after five days.

Coyle and co-authors say that they were fortunate their patient was highly motivated and committed to following treatment guidelines. While limited data currently exist, more extensive research is needed to determine appropriate guidelines, better understanding of risks and clear indications of how medications and treatments affect the fetus.

"A Successful 39-Week Pregnancy on Hemodialysis: A Case Report." Mary Coyle, MS, FNP; Elyn Sulger, BSN, RN, CNN, CAN-BC, CPHQ, LNC; Cindy Fletcher, MSW, LMSW; and Diane Rouse, MS, RD, CDN Nephrology Nursing Journal; July-August 2008; http://www.annanurse.org/journal

Nephrology Nursing Journal is a refereed clinical and scientific resource that provides current information on a wide variety of subjects to facilitate the practice of professional nephrology nursing. Its purpose is to disseminate information on the latest advances in research, practice, and education to nephrology nurses to positively influence the quality of care they provide.

Nephrology Nursing Journal