For women with chronic kidney disease (CKD), getting pregnant is very rare,
and a successful pregnancy is even more uncommon, especially for women on
dialysis.
In the July-August 2008 issue of *Nephrology Nursing Journal,* Mary Coyle
and co-authors present a case report of a 35-year-old woman with Stage 5 CKD
who successfully completed a 39-week pregnancy while on hemodialysis. The
pregnancy was diagnosed at seven weeks, and five three-hour hemodialysis
sessions per week were started right away, say the authors.
A care team was assigned to the patient and her family, which included a
nephrologist, a dialysis center nurse practitioner, a nurse manager, a
dietician, a social worker, and a core group of nurses who would dialyze
her. This group, say the authors, was crucial in monitoring signs and
symptoms and maintaining a continuum of care. The care team used
recommendations in the available literature to manage blood urea nitrogen
levels, fluid removal by ultrafiltration and other issues.
The nurse practitioner also shared status updates with the perinatologist
and perinatal center nurse practitioner throughout the pregnancy. The
perinatologist saw the patient every two weeks and with greater frequency
when she reached 24 weeks.
The patient's anemia worsened during the pregnancy, and she also developed
hypertension, pre-eclampsia and polyhydramnios, all common among women on
dialysis. Despite these complications, fetal heart rate testing and OB
ultrasounds revealed an active, growing fetus. A scheduled cesarean section
took place at 39 weeks, and the patient delivered a five-pound, seven-ounce
daughter. Mother and baby were discharged after five days.
Coyle and co-authors say that they were fortunate their patient was highly
motivated and committed to following treatment guidelines. While limited
data currently exist, more extensive research is needed to determine
appropriate guidelines, better understanding of risks and clear indications
of how medications and treatments affect the fetus.
*"A Successful 39-Week Pregnancy on Hemodialysis: A Case Report."* Mary
Coyle, MS, FNP; Elyn Sulger, BSN, RN, CNN, CAN-BC, CPHQ, LNC; Cindy
Fletcher, MSW, LMSW; and Diane Rouse, MS, RD, CDN *Nephrology Nursing
Journal*; July-August 2008; http://www.annanurse.org/journal
*Nephrology Nursing Journal *is a refereed clinical and scientific resource
that provides current information on a wide variety of subjects to
facilitate the practice of professional nephrology nursing. Its purpose is
to disseminate information on the latest advances in research, practice, and
education to nephrology nurses to positively influence the quality of care
they provide.
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