Pregnancy in patients on dialysis--experience at a referral center.
OBJECTIVE
Pregnancy is infrequent in women with end-stage renal disease. The frequency of conception in dialysis patients has been reported as 0.3% to 1.4% in different studies from different countries. In the present study the frequency and outcome of pregnancies from a referral center in Saudi Arabia from January 1992 to December 2003 is reported.


METHODS
All females on maintenance hemodialysis (MHD) and chronic peritoneal dialysis (CPD) were reviewed. Files of the patients in childbearing age (less than 50 years) were analyzed for the frequency of pregnancy, mode of dialysis, complications and outcome. Of the 192 females taken for MHD and CPD, 113 were of the childbearing age. Five patients were already on HD when they became pregnant, the period on HD varied from 7-34 (mean = 24) months and in 4 dialysis was initiated during first pregnancy. (Abortion was defined as termination of pregnancy before 22 weeks of gestation. Perinatal mortality was taken as death of a viable fetus after 22 weeks of gestation or within 4 weeks after delivery. Preterm was defined as delivery before 37 weeks of gestation and low birth weight as a baby weighing less than 2500 gm at birth).


RESULTS
Twelve pregnancies were noted in 9 patients (7.9%) with a yearly frequency of 0.66%. All pregnancies were noted in patients on MHD and none on CPD. Seven pregnancies (58%) ended in live births and all were preterm deliveries in the range of 27-36 (mean 31.5) weeks. All babies were low birth weight ranging from 1115-2300 (mean 1700) gram. Three deliveries were spontaneous vaginal and 4 underwent lower segment cesarean sections. Two deliveries ended in perinatal mortality. Three pregnancies ended in spontaneous abortions between 10-20 (mean 12) weeks. One woman had 3 pregnancies, the last one ending in antepartum hemorrhage, hysterotomy and hysterectomy for rupture of uterus. Another patient had 2 pregnancies. No congenital abnormalities were noted in any of the live births.


CONCLUSIONS
Pregnancy though uncommon in women on dialysis can occur. Preterm deliveries with low birth weight are usual though live birth rate of 58% was observed. In view of the need for increased frequency of dialysis for successful outcome, planning the pregnancy and high chances of dangerous complications, early diagnosis of pregnancy in a patient on dialysis essential.
Malik
G H
GH
Nephrology Division, Department of Internal Medicine, OB/Gyne Department, Security Forces Hospital Program, Riyadh, KSA.
Al-Harbi
A
A
Al-Mohaya
S
S
Dohaimi
H
H
Kechrid
M
M
Shetaia
M S
MS
Al-Hassan
A Os
AO
Quiapos
Laura S
LS
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D047928:Premature Birth; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D012529:Saudi Arabia