The conception in hemodialysis: medical prognosis and experience of the gynecology-obstetrics department of Oujda on two cases

Graiti Ghizlane; Taheri Hafsa; Bellejdel Ibtissam; Mimouni Ahmed; Saadi Hanane

doi:10.18203/2320-1770.ijrcog20243203

Authors

Graiti Ghizlane Department of Obstetrics and Gynecology, Mohammed VI University Hospital Center, (University of Mohammed First, Oujda), Morocco
Taheri Hafsa Department of Obstetrics and Gynecology, Mohammed VI University Hospital Center, (University of Mohammed First, Oujda), Morocco
Bellejdel Ibtissam Department of Obstetrics and Gynecology, Mohammed VI University Hospital Center, (University of Mohammed First, Oujda), Morocco
Mimouni Ahmed Department of Obstetrics and Gynecology, Mohammed VI University Hospital Center, (University of Mohammed First, Oujda), Morocco
Saadi Hanane Department of Obstetrics and Gynecology, Mohammed VI University Hospital Center, (University of Mohammed First, Oujda), Morocco

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20243203

Keywords:

Pregnancy, Chronic hemodialysis, Conception, End stage renal failure

Abstract

Pregnancy in patients undergoing hemodialysis is a rare occurrence, particularly in Africa where therapeutic resources are limited, and is associated with high maternal-fetal risks. However, the incidence of pregnancies in such patients has increased over the past two decades, with notable improvements in prognosis and fetal survival, reaching 68.4% in some studies. This report describes two cases of pregnancy in patients with end-stage renal disease (ESRD) on chronic hemodialysis at the Mohammed VI university hospital center in Oujda, Morocco. The first case involved a patient whose pregnancy was managed up to 36 weeks of gestation, resulting in the delivery of a live newborn weighing 1600 gm. This outcome was achieved through careful control of blood pressure, management of dry weight, acceptable hemoglobin levels, and optimization of hemodialysis sessions. The second case was more complicated, involving a congenital malformation (omphalocele) that led to preterm labor at 25 weeks. The premature infant, weighing 600 gm, unfortunately died two hours after birth. This observational study highlights the challenges of managing pregnancy in patients on chronic hemodialysis and underscores the importance of multidisciplinary care to improve outcomes. A review of the literature is also provided to contextualize these findings.

Metrics

Metrics Loading ...

References

Okundaye I, Abrinko P, Hou S. Registry of pregnancy in dialysis patients. Am J Kidney Dis. 1998;31(5):766-73.

Levy D, Giatras I, Jungers P. Pregnancy and end-stage renal disease - past experience and new insights. Nephrology Dialysis Transplantation. 1998;13(12):3005-7.

Holley JL, Schmidt RJ, Bender FH, Dumler F, Schiff M. Gynecologic and reproductive issues in women on dialysis. Am J Kidney Dis. 1997;29(5):685-90.

Schmidt RJ, Holley JL. Fertility and Contraception in End-Stage Renal Disease. Adv Renal Replacement Therapy. 1998;5(1):38-44.

Palmer BF. Sexual Dysfunction in Uremia. J Am Society of Nephrol. 1999;10(6):1381-8.

Marchetti T, Cohen M, De Moerloose P. Obstetrical Antiphospholipid Syndrome: From the Pathogenesis to the Clinical and Therapeutic Implications. Clin Develop Immunol. 2013;2013;1-9.

Pagnoux C, Mahendira D, Laskin CA. Fertility and pregnancy in vasculitis. Best Practi Res Clin Rheumatol. 2013;27(1):79-94.

Mersereau J, Dooley MA. Gonadal Failure with Cyclophosphamide Therapy for Lupus Nephritis: Advances in Fertility Preservation. Rheumatic Dis Clin N Am. 2010;36(1):99-108.

Milde FK, Hart LK, Fearing MO. Sexuality and fertility concerns of dialysis patients. ANNA J. 1996;23(3):307-13.

Kurtulus FO, Salman MY, Fazlioglu A, Fazlioglu B. Effects of Renal Transplantation on Female Sexual Dysfunction: Comparative Study with Hemodialysis and a Control Group. Transplantation Proceedings. 2017;49:2099-104.

Sadek HB, Kejji S, Rhou H, Ezzaitouni F, Ouzeddoun N, Bayahia R, et al. Grossesse chez les patientes hémodialysées chroniques. J Gynécol Obstétr Biol Reproduct. 2011;40(5):452-9.

Chaker H, Masmoudi S, Salma T, Najla D, Jamil H, Khawla K, et al. La grossesse en hémodialyse chronique: à propos de 25 cas survenus dans le Sud Tunisien. Pan Afr Med J. 2020;36:195.

Raharivelina CA, Randriamanantsoa LN, Vololontiana D, Ralaifonenana J, Rakotomanga M, Rabenantoandro R. Hemodialysis in pregnancy. Nephrologie. 2003;24(6):283-6.

Doukkali B, Bahadi A, Rafik H, Kabba D, Benyahia M. La grossesse chez les hémodialysées chroniques. Pan Afr Med J. 2015;20(213):1-5.

Chang JY, Hanbeol J, Byung HC, Young-Ah Y, In-Kyung S, Yong-Soo K, et al. The successful clinical outcomes of pregnant women with advanced chronic kidney disease. Kidney Res Clin Pract. 2016;35(2):84-9.

Potluri K, Moldenhauer J, Karlman R, Hou S. Beta HCG levels in a pregnant dialysis patient: a cautionary tale. Clin Kidney J. 2011;4:42-3.

Piccoli GB, Fosca M, Elisabetta V, Gianfranca C, Rossella A, Federica NV, et al. Pregnancy in dialysis patients in the new millennium: a systematic review and meta-regression analysis correlating dialysis schedules and pregnancy outcomes. Nephrol Dial Transplant. 2016;31(11):1915-34.

Werner EF, Han CS, Pettker CM, Buhimschi CS, Copel JA, Funai EF, et al. Universal cervical‐length screening to prevent preterm birth: a cost‐effectiveness analysis. Ultrasound in Obstet Gyne. 2011;38(1):32-7.

Shemin, D. Dialysis in Pregnant Women with Chronic Kidney Disease. Seminars in Dialysis. 2003;16:379-83.

Hladunewich MA. Intensive Hemodialysis Associates with Improved Pregnancy Outcomes: A Canadian and United States Cohort Comparison. J Am SocNephrol. 2014;25:1103-9.

Luders C, Titan SM, Kahhale S, Francisco RP, Zugaib M. Risk Factors for Adverse Fetal Outcome in Hemodialysis Pregnant Women. Kidney Int Rep. 2018;3:1077-88.

Barua M, Michelle H, Johannes K, Andreas P, Philip M, Manish S, et al. Successful Pregnancies on Nocturnal Home Hemodialysis. Clin J Am Soc Nephrol. 2008;3(2):392-6.

Hou S. Pregnancy in chronic renal insufficiency and end-stage renal disease. Am J Kidney Dis. 1999;33:235-52.

Bertholdt C, Fijean AL, Morel O, Zuily-Lamy C. Issue postnatale en cas d’hydramnios sans anomalies morphologiques à l’échographie anténatale. Gynécol Obstét Fertil Sénol. 2020;48:162-6.