SUGGESTED ULTRASOUND PARAMETERS FOR THE ASSESSMENT OF FETAL WELL-BEING DURING CHRONIC-HEMODIALYSIS

There are no published guidelines on how to assess fetal well-being du ring hemodialysis. We have developed a specific protocol of renal and obstetric interventions to ensure that hemodialysis is associated with minimal changes in fetal status. We tested this protocol serially ove r a 9-week period in a pregnant patient who was undergoing chronic hem odialysis for end-stage renal disease. Testing involved serial assessm ents of uterine and umbilical artery blood flow with Doppler velocimet ry and continuous fetal heart rate tracings, before, during and after each hemodialysis session. We found that, by strict adherence to these guidelines, there were no significant alterations in maternal mean ar terial blood pressure, continuous fetal heart rate tracings, uterine a rtery systolic/diastolic ratios, or umbilical artery systolic/diastoli c ratios. We conclude that stable uteroplacental and fetal perfusion c an be maintained during chronic hemodialysis in pregnancy by adhering to a specific set of precautions.