Fofana Aboubacar Sidiki, Samaké Magara, Sy Seydou, Dembélé Sitapha, Sissoko Ousmane Massa, Diakité Niagalé, Coulibaly Sah Dit Baba, Tounkara Pinda, Coulibaly Moctar, Djiguiba Singadou Ousmane Youssouf, Yattara Hamadoun, Fongoro Saharé
Nephrology Unit, Fousseyni Daou Hospital, Kayes, Mali.
National Center of Scientific and Technology research, Bamako, Mali.
BMC Nephrol. 2025 May 28;26(1):262. doi: 10.1186/s12882-025-04202-3.
Conception in hemodialysis is a rare event with an incidence of 0.5-1.4% of women of childbearing age, and associated with a high maternal-fetal risk. We report a case of full-term pregnancy with live child that occurred in our hemodialysis center at Kayes Hospital in Mali.
The patient was 38 years old and had been on chronic hemodialysis for 4 years for hypertensive nephropathy. She was dialyzed twice a week for 8 h. We discovered a pregnancy of 17 weeks' amenorrhea (WA) in a context of acute pelvic pain. Hemodialysis was immediately intensified to 3 times/week for 4 h 30 min until 32 weeks' amenorrhea, then 4 times/week for 4 h 30 min until term. Thanks to blood pressure control, dry weight control and hemoglobin control at around 12 g/dl on erythropoietin, the pregnancy was carried to 36 SA + 6 days, with vaginal delivery resulting in a live infant weighing 2800 g. The newborn's renal function at 24 and 48 h was normal, with a mean hemoglobin level of 17 g/dl.
Pregnancy in chronic hemodialysis is a very high-risk maternal and fetal condition. This first observation in Mali shows that procreation is possible for hemodialysis recipients despite limited resources. Multidisciplinary management, combined with blood pressure control, intensification of hemodialysis and correction of anemia, guarantee the best results.
血液透析患者怀孕是罕见事件，育龄女性的发生率为0.5%-1.4%，且母婴风险高。我们报告了一例在马里卡耶斯医院血液透析中心发生的足月妊娠并产下活婴的病例。
患者38岁，因高血压肾病接受慢性血液透析4年。她每周透析两次，每次8小时。在急性盆腔疼痛的情况下，我们发现她停经17周时怀孕。血液透析立即强化为每周3次，每次4小时30分钟，直至停经32周，然后每周4次，每次4小时30分钟直至足月。由于通过使用促红细胞生成素将血压、干体重和血红蛋白控制在12g/dl左右，妊娠持续至孕36周+6天，经阴道分娩出一名体重2800g的活婴。新生儿在24小时和48小时时肾功能正常，平均血红蛋白水平为17g/dl。
慢性血液透析患者怀孕是母婴极高风险的情况。在马里的这首例观察表明，尽管资源有限，血液透析患者仍有可能生育。多学科管理，结合血压控制、强化血液透析和纠正贫血，可确保取得最佳效果。
