Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Fetal Diagn Ther 2007;22:289–293 DOI: 10.1159/000100793 Pregnancy on Intensified Hemodialysis: Fetal Surveillance and Perinatal Outcome Christian Bamberg a Fritz Diekmann b Michael Haase b Klemens Budde b Berthold Hocher b Horst Halle a John Hartung a Departments of a Obstetrics and Gynecology and b Nephrology, Charité University Hospital, Campus Mitte, Berlin, Germany Introduction Pregnancy is still uncommon among women suffering from end-stage renal disease undergoing chronic dialysis [1, 2], but there is a widespread impression that due to improved dialysis techniques the conception rate among such patients has increased. Pregnancy management for women undergoing chronic hemodialysis (HD) is difficult [3]. Miscarriage, perinatal death, preterm delivery, intrauterine growth re- tardation (IUGR), and polyhydramnios, as well as mater- nal hypertension and pre-eclampsia, remain common complications. However, pregnancy in women on dialysis is more likely to be successful than it was in the past: in 1980 the reported rate of surviving infants was 23% in a retrospective registry analysis [4], in 1998 a successful outcome of 50% was described in a national survey [2], and in the same year a single-center study reported a suc- cess rate of up to 70.7% among 17 pregnant women on dialysis [5]. The improvement in fetal outcome is likely the result of successful multidisciplinary management by obstetricians, nephrologists, and neonatologists, with in- tensified dialysis, better anemia management, and im- proved perinatal monitoring. Preterm delivery, usually before 32 weeks’ gestation [3, 6] , and fetal distress are still the primary perinatal com- plications for pregnant women on dialysis. Fetal distress is likely a consequence of major dialysis and related com- plications such as shifts in acute fluid volume, electrolyte imbalance, and hypotension, which impair uteroplacen- Key Words Pregnancy, intensified hemodialysis  Hemodialysis, fetal surveillance  Hemodialysis, perinatal outcome  Intensive fetal surveillance  Maintenance dialysis, pregnant women  Doppler ultrasound  Cardiotocography Abstract Objectives: To evaluate the effect of intensive fetal surveil- lance via Doppler ultrasound and fetal non-stress test on the perinatal outcome of pregnant women undergoing an in- tensified hemofiltration scheme. Methods: Five consecutive pregnancies of women undergoing intensified hemodialysis were analyzed due to the following parameters: maternal background, hemodialysis schedule during pregnancy, blood pressure, occurrence of fetal complications, occur- rence of obstetric complications, gestational week at deliv- ery, mode of delivery, and newborn outcome and follow-up. Results: All pregnancies resulted in a live birth, mean gesta- tional age was 32 weeks. Intrauterine growth restriction oc- curred in 4 fetuses, pathological umbilical artery flow veloc- ity waveforms in 2. The mean birth weight was 1,764 g (range 1,274–2,465 g). Cesarean section was performed in 3 pa- tients because of fetal distress. None of the patients devel- oped severe complications like pre-eclampsia. Conclusions: Although intensified dialysis enables the maintenance of stable uteroplacental and fetal perfusion, intensive fetal monitoring is mandatory to reduce perinatal morbidity and mortality in pregnant women on maintenance dialysis. Copyright © 2007 S. Karger AG, Basel Received: February 28, 2006 Accepted after revision: June 27, 2006 Published online: March 15, 2007 Dr. John Hartung Praxis für Pränatale Diagnostik und Ultraschall Schlossstrasse 88 DE–12163 Berlin (Germany) Tel. +49 30 7974 6089, Fax +49 30 7974 6088, E-Mail john.hartung@t-online.de © 2007 S. Karger AG, Basel 1015–3837/07/0224–0289$23.50/0 Accessible online at: www.karger.com/fdt Downloaded by: Charité - Universitätsmedizin Berlin 193.175.73.217 - 6/28/2016 12:55:19 PM