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      Successful pregnancy and delivery in uremic patients with maintenance hemodialysis : A case report

      case-report
      , MD a , , MD, PhD a , , BA a , , MD, PhD b , , MD a , , MD a , , MD, PhD a ,
      Medicine
      Wolters Kluwer Health
      chronic kidney disease, hemodialysis, pregnancy, uremia

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          Abstract

          Rationale:

          It is reported that successful pregnancies in dialyzed uremic women are rare. Over the past years, despite advances in clinical management and technology in dialysis for pregnancy in patients receiving maintenance hemodialysis, uremia remains a high risk factor for adverse outcomes in mother and fetus.

          Patient concerns:

          In this article, we present a case of pregnancy in a 34-year-old uremic woman on dialysis. After the pregnancy was diagnosed and confirmed, intensive dialysis and multidisciplinary care according to the recommendations in the available literatures were provided.

          Diagnoses:

          Single pregnancy of 31 +4 GWs (gestational weeks), fetal growth restriction, polyhydramnios, and uremia.

          Outcomes:

          At 31 weeks’ gestation and 4 days, she was admitted to our hospital due to premature rupture of membranes and abdominal pain. Then a female baby weighed 1700 g was delivered successfully. After one year of follow-up, the mother feels well and the baby is healthy.

          Lessons:

          Intensive dialysis, detailed management and multidisciplinary approaches are necessary for optimal outcomes in uremic pregnant mother and fetus.

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          Most cited references15

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          Maternal anemia during pregnancy is an independent risk factor for low birthweight and preterm delivery.

          The present study was designed to investigate the outcome of pregnancy and delivery in patients with anemia. A retrospective population-based study comparing all singleton pregnancies of patients with and without anemia was performed. Deliveries occurred during the years 1988-2002 in the Soroka University Medical Center. Maternal anemia was defined as hemoglobin concentration lower than 10 g/dl during pregnancy. Patients with hemoglobinopathies such as thalassemia were excluded from the analysis. Multiple logistic regression models were performed to control for confounders. During the study period there were 153,396 deliveries, of which 13,204 (8.6%) occurred in patients with anemia. In a multivariable analysis, the following conditions were significantly associated with maternal anemia: placental abruption, placenta previa, labor induction, previous cesarean section (CS), non-vertex presentation and Bedouin ethnicity. Higher rates of preterm deliveries (<37 weeks gestation) and low birthweight (<2500 g) were found among patients with anemia as compared to the non-anemic women (10.7% versus 9.0%, p < 0.001 and 10.5% versus 9.4%, p < 0.001; respectively). Higher rates of CS were found among anemic women (20.4% versus 10.3%; p < 0.001). The significant association between anemia and low birthweight persisted after adjusting for gender, ethnicity and gestational age, using a multivariable analysis (OR = 1.1; 95% CI 1.0-1.2, p = 0.02). Two multivariable logistic regression models, with preterm delivery (<37 weeks gestation) and low birthweight (<2500 g) as the outcome variables, were constructed in order to control for possible confounders such as ethnicity, maternal age, placental problems, mode of delivery and non-vertex presentation. Maternal anemia was an independent risk factor for both, preterm delivery (OR = 1.2; 95% CI 1.1-1.2, p < 0.001) and low birthweight (OR = 1.1; 95% CI 1.1-1.2, p = 0.001). Maternal anemia influences birthweight and preterm delivery, but in our population, is not associated with adverse perinatal outcome.
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            Chronic kidney disease in pregnancy.

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              Pregnancy in dialysis patients in the new millennium: a systematic review and meta-regression analysis correlating dialysis schedules and pregnancy outcomes.

              Advances have been made in the management of pregnancies in women receiving dialysis; however, single-centre studies and small numbers of cases have so far precluded a clear definition of the relationship between dialysis schedules and pregnancy outcomes. The aim of the present systematic review was to analyse the relationship between dialysis schedule and pregnancy outcomes in pregnancies in chronic dialysis in the new millennium.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                December 2018
                14 December 2018
                : 97
                : 50
                : e13614
                Affiliations
                [a ]Department of Nephrology
                [b ]Department of Gynaecology and Obstetrics, Affiliated Hospital of Nantong University, Nantong, China.
                Author notes
                []Correspondence: Houyong Dai, Department of Nephrology, Affiliated Hospital of Nantong University, Nantong 226001, China (e-mail: daihy520@ 123456126.com ).
                Article
                MD-D-18-05725 13614
                10.1097/MD.0000000000013614
                6320043
                30558039
                f9220861-478c-4f2c-844b-0583f5f6573a
                Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

                History
                : 16 August 2018
                : 19 November 2018
                Categories
                5200
                Research Article
                Clinical Case Report
                Custom metadata
                TRUE

                chronic kidney disease,hemodialysis,pregnancy,uremia
                chronic kidney disease, hemodialysis, pregnancy, uremia

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