Hadj Sadek B, Kejji S, Rhou H, Ezzaitouni F, Ouzeddoun N, Bayahia R, Benamar L
Service de néphrologie-dialyse et transplantation rénale, CHU Ibn Sina, Rabat, Morocco.
J Gynecol Obstet Biol Reprod (Paris). 2011 Sep;40(5):452-9. doi: 10.1016/j.jgyn.2011.04.003. Epub 2011 May 18.
Pregnancy in hemodialysis patients is a rare event, with a high risk of maternal and fetal morbidity. The aim of our study is to report our experience in management of pregnancies occurred in hemodialysis patients, and clarify the factors of good prognosis.
We identified all pregnancies occurred in patients on hemodialysis between January 2000 and July 2010, and analysed their clinical and biological characteristics. The adjustment parameters of hemodialysis sessions, and treatment adjustments have been specified. The maternal and fetal complications and pregnancy outcome have been reported.
Over a period of 10 years and 6 months, among 23 patients of childbearing age, 14 patients were married. We observed 11 pregnancies in eight patients, with an incidence of 7,14% year, and a prevalence of 71,4%. The evolution was marked by intrauterine fetal death in one case, medical pregnancy termination in a second one and four spontaneous abortions. Only five pregnancies were completed. The average age of conception was 34 years. The average duration of dialysis prior to conception was 76 months. Pregnancy diagnosis was made on average after 10,4 weeks. The mean gestational age at delivery was 33,6 weeks, and the mean newborn weight was 2070g. Apgar score was of 10/10 in the first minute in all newborns. No maternal complication was found. One case of intrauterine growth restriction and another case of pyelo-caliceal dilatation with resolving renal insufficiency were reported. In the long term, the fetal psychomotor development was normal.
The fertility chronic hemodialysis patients in childbearing age have improved together with the quality of dialysis, with an increased incidence of pregnancy and the proportion of viable children. However, treatment modalities are not clearly established, because of the absence of randomized studies and the small number of pregnancies during the playoffs. Treatment of anemia with erythropoietin and blood transfusions, and the improvement in blood urea by extensive dialysis in women on hemodialysis, may improve outcomes by reducing the incidence of prematurity and increasing gestational age.
Pregnancy in hemodilalysis patient is a rare event, but desired and valuable. Its completion requires a multidisciplinary management involving the nephrologist to ensure adequate dialysis and the gynecologist to ensure good obstetrical monitoring.
血液透析患者怀孕是罕见事件，母婴发病风险高。我们研究的目的是报告我们在管理血液透析患者怀孕方面的经验，并阐明良好预后的因素。
我们确定了2000年1月至2010年7月期间血液透析患者发生的所有怀孕情况，并分析了其临床和生物学特征。明确了血液透析疗程的调整参数以及治疗调整。报告了母婴并发症及妊娠结局。
在10年零6个月的时间里，23名育龄患者中14名已婚。我们观察到8名患者中有11次怀孕，年发病率为7.14%，患病率为71.4%。病情发展表现为1例宫内胎儿死亡、1例药物性终止妊娠以及4例自然流产。仅5次怀孕足月。平均受孕年龄为34岁。受孕前平均透析时间为76个月。平均在10.4周后确诊怀孕。分娩时平均孕周为33.6周，新生儿平均体重为2070克。所有新生儿出生后1分钟阿氏评分均为10分（满分10分）。未发现母体并发症。报告了1例胎儿生长受限以及另1例肾盂肾盏扩张伴肾功能不全缓解的病例。从长远来看，胎儿精神运动发育正常。
随着透析质量的提高，育龄期慢性血液透析患者的生育能力有所改善，怀孕发生率及存活子女比例增加。然而，由于缺乏随机研究且病例数较少，治疗方式尚未明确确立。血液透析女性使用促红细胞生成素和输血治疗贫血，以及通过广泛透析改善血液尿素水平，可能通过降低早产发生率和增加孕周来改善结局。
血液透析患者怀孕是罕见事件，但值得期待且有价值。其成功需要多学科管理，包括肾病学家确保充分透析以及妇科医生确保良好的产科监测。
