Dialysis and pregnancy - A case report and review of the literature

We report on a patient with an eight-year history on maintenance hemodialys is treatment without residual renal function in whom pregnancy was successf ully managed through to the 29th week. During this time, under carefully mo dified dialysis treatment the nephrologic course, as well as materno-fetal flow relationships were unremarkable. Fetal development was appropriate for gestational age. However, pregnancy was complicated by polyhydramnios, whi ch necessitated i.v, tocolysis. In the 28 + 6th week of gestation, cesarean section was performed because of an antibiotic-resistant fever of unclear origin which ceased within two days of delivery Although the postnatal cour se of the adequately developed baby was complicated by the respiratory mist ress syndrome, normal development continued We emphasize that the intensive interdisciplinary cooperation of nephrologi sts and obstetricians is imperative for the successful management of pregna ncy under these conditions. In these pregnancies, the main fetal problems c onsist of premature labor because of polyhydramnios, preterm delivery, intr auterine growth retardation and stillbirth. The mother is threatened by the development of superimposed pre-eclampsia, left ventricular failure becaus e of volume overload and progressive anemia, In order to maintain a well-ba lanced homeostasis, intensification of dialysis therapy by an increase in f requency and duration is the most important therapeutic approach. Accurate fetal monitoring including frequent examination of the feto-maternal circul ation by Dopplersonography as well as attentive surveillance of the mother is required to recognize the above mentioned complications.