title: Effect of dialysis on fetal heart rate: is inpatient admission for fetal monitoring necessary?
abstract: OBJECTIVE
  Pregnant patients receiving hemodialysis (HD) have long hospital stays for the purpose of electronic fetal monitoring (EFM) during HD, which allows for monitoring of fetal well-being. However, more frequent dialysis allows for smaller fluid shifts, preventing maternal hypotension. Our aim was to determine differences in rates of EFM abnormalities during HD versus non-stress testing (NST) off dialysis for gravid women with renal failure.
  
  
  METHODS
  Retrospective cohort study over a 13-year period (2000-2013) identified five patients with renal failure in pregnancy. EFM tracings were reviewed during HD (cases) and routine inpatient NST off HD (controls). Standardized nomenclature was used to identify EFM abnormalities. The rate of abnormalities per hour of EFM was calculated. Kruskal-Wallis test was used and statistical significance was set at p < 0.05.
  
  
  RESULTS
  There were no significant differences in late decelerations (p = 0.2) between cases and controls. Significantly fewer variable decelerations (p = 0.01) and contractions (p ≤0.001) were noted during dialysis compared to controls. Significantly more prolonged decelerations (p = 0.02) were noted during HD compared to controls.
  
  
  CONCLUSIONS
  There may be no fetal benefit of EFM during HD for gravid women with renal disease attributed to hypertensive and diabetic nephropathy. There may be cost savings by shifting HD to the outpatient setting.
authors.affiliation: a Department of Obstetrics , Gynecology, & Women's Health, John A. Burns School of Medicine, University of Hawaii , Honolulu , HI , USA.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Loichinger
authors.affiliation: a Department of Obstetrics , Gynecology, & Women's Health, John A. Burns School of Medicine, University of Hawaii , Honolulu , HI , USA.
authors.forename: Autumn J
authors.initials: AJ
authors.lastname: Broady
authors.affiliation: a Department of Obstetrics , Gynecology, & Women's Health, John A. Burns School of Medicine, University of Hawaii , Honolulu , HI , USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Yamasato
authors.affiliation: a Department of Obstetrics , Gynecology, & Women's Health, John A. Burns School of Medicine, University of Hawaii , Honolulu , HI , USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Mills
authors.affiliation: a Department of Obstetrics , Gynecology, & Women's Health, John A. Burns School of Medicine, University of Hawaii , Honolulu , HI , USA.
authors.forename: P Gordon
authors.initials: PG
authors.lastname: McLemore
authors.affiliation: a Department of Obstetrics , Gynecology, & Women's Health, John A. Burns School of Medicine, University of Hawaii , Honolulu , HI , USA.
authors.forename: Dena
authors.initials: D
authors.lastname: Towner
mesh_terms: D000328:Adult; D015148:Cardiotocography / Q000379:methods*; D016022:Case-Control Studies; D005260:Female; D006340:Heart Rate, Fetal / Q000502:physiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008137:Longitudinal Studies; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors
keywords: Hemodialysis; non-stress test; pregnancy; renal disease; renal insufficiency