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Successful multigravid pregnancy in a 42-year-old patient on continuous ambulatory peritoneal dialysis and a review of the literature.

Published on Dec 1, 2017in BMC Nephrology2.088
· DOI :10.1186/s12882-017-0540-7
Thiam Seong Christopher Lim1
Estimated H-index: 1
(UPM: Universiti Putra Malaysia),
Malini Shanmuganathan1
Estimated H-index: 1
+ 1 AuthorsBak Leong Goh9
Estimated H-index: 9
Sources
Abstract
Background For peritoneal dialysis patients, the likelihood of conception is low and the probability of getting through the pregnancy successfully is even lower. Almost 60 years after the first reported case of a successful pregnancy in a dialysis patient, many issues concerning pregnancy in dialysis patients remain unresolved. Our patient’s pregnancy is considered high risk as she has end stage renal failure and falls in the category of advance maternal age for pregnancy. We describe here the course of her uneventful pregnancy which we hope will contribute to the overall knowledge and management of pregnancy in elderly patients receiving peritoneal dialysis.
  • References (15)
  • Citations (2)
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References15
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#1Gianfranca CabidduH-Index: 18
#2Santina CastellinoH-Index: 5
Last. Giorgina Barbara Piccoli (UNITO: University of Turin)H-Index: 31
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Background Pregnancy during dialysis is increasingly being reported and represents a debated point in Nephrology. The small number of cases available in the literature makes evidence-based counselling difficult, also given the cultural sensitivity of this issue. Hence, the need for position statements to highlight the state of the art and propose the unresolved issues for general discussion.
19 CitationsSource
#1Rodolfo R. Batarse (UCSD: University of California, San Diego)H-Index: 2
#2Ralph M. SteigerH-Index: 1
Last. Steven Guest (Baxter International)H-Index: 10
view all 3 authors...
Management of the pregnant patient on peritoneal dialysis (PD) is potentially challenging because uterine enlargement may negatively affect catheter function and prescribed dwell volumes. Additiona...
8 CitationsSource
Background and objectives: Although successful pregnancy is rare, results attained with higher dialysis efficiency and the spread of dialysis to different cultural and religious settings are changing the panorama. In this study, we systematically review the recent literature (2000 through 2008) on pregnancy in dialysis. Design, setting, participants, & measurements: Medline on OVID was searched in November 2008, with MESH and free terms on pregnancy and chronic kidney disease or dialysis; limits...
74 CitationsSource
Background and objectives: Women of childbearing age on conventional hemodialysis (CHD) have decreased fertility when compared with the general population. Even in women who conceived, maternal morbidity and fetal mortality remained elevated. We hypothesized that nocturnal hemodialysis (NHD) (3 to 6 sessions per week, 6 to 8 h per treatment), by augmenting uremic clearance, leads to a more hospitable maternal environment and therefore superior outcomes in fertility and pregnancy compared with CH...
127 CitationsSource
#1Károly SchneiderH-Index: 1
#2Sándor FerencziH-Index: 1
Last. Zsolt PappH-Index: 1
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6 CitationsSource
#1Mustafa Altay (Military Medical Academy)H-Index: 1
#2Izzet Yavuz (Military Medical Academy)H-Index: 4
Last. Murat Duranay (Military Medical Academy)H-Index: 13
view all 4 authors...
Sir, Patients undergoing chronic dialysis often believe they are unable to conceive, because of irregular menstruations and decreased libido; consequently, they do not regularly use contraceptive methods. Pregnancy is detected late, particularly in patients on peritoneal dialysis [1]. Early detection of pregnancy in dialysis patients is very important, in order to choose adequate methods for follow-up and treatment; late diagnosis increases the risk of maternal and foetal complications. We prese...
4 CitationsSource
#1Smith Wt (Lenox Hill Hospital)H-Index: 1
#2Darbari S (Lenox Hill Hospital)H-Index: 1
Last. Maria V. DeVita (Lenox Hill Hospital)H-Index: 15
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A case of pregnancy in a 27-year-old woman on peritoneal dialysis is presented. The case report is a detailed description of her course including changes in her peritoneal dialysis regimen and the use of continuous cycling to maximize dialysis adequacy while addressing the patient's recurrent abdominal pain and fullness. Also described is the management of complications including hypertension, gestational diabetes, and premature rupture of membranes. The discussion reviews the diagnosis of pregn...
23 CitationsSource
#1Jean Lake Holley (UVA: University of Virginia)H-Index: 26
#2Sai Subhodhini Reddy (UR: University of Rochester)H-Index: 4
Although uncommon, pregnancy occurs in women on chronic dialysis. In 1980 the incidence of pregnancy in women on dialysis was 0.9%. Studies from 1992 to 2003 indicate that pregnancy occurred in 1–7% of women on chronic dialysis. Half of the infants born to women on chronic dialysis survive. Of importance is that ‘‘intensive dialysis’’ of 16–24 hr/week is associated with improved infant survival. In this article, the incidence, duration, fetal and maternal complications, and outcomes of pregnancy...
115 CitationsSource
#1Jean Lake Holley (UVA: University of Virginia)H-Index: 26
#2Sai Subhodhini Reddy (UR: University of Rochester)H-Index: 4
Although uncommon, pregnancy occurs in women on chronic dialysis. In 1980 the incidence of pregnancy in women on dialysis was 0.9%. Studies from 1992 to 2003 indicate that pregnancy occurred in 1–7% of women on chronic dialysis. Half of the infants born to women on chronic dialysis survive. Of importance is that ‘‘intensive dialysis’’ of 16–24 hr/week is associated with improved infant survival. In this article, the incidence, duration, fetal and maternal complications, and outcomes of pregnancy...
98 CitationsSource
#1M JollyH-Index: 13
#2Neil J. SebireH-Index: 70
Last. Lesley ReganH-Index: 59
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The obstetric risks of adverse outcome during pregnancy in women aged greater than or equal to 35 years were quantified using a retrospective analysis of data from 385 120 singleton pregnancies in the North West Thames Region, UK, between 1988 and 1997, A comparison of pregnancy outcome was made on the basis of maternal age at delivery: 18-34 years (n = 336 462), 35-40 years (n = 41 327) and women aged >40 years (n = 7331). Women aged 40 year old women, with adjusted odds ratios (OR) according t...
313 CitationsSource
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Background: Chronic kidney disease (CKD) is associated with reduction of fertility and increased complications during pregnancy. The aim of this work is to analyze the clinical outcomes and risk factors in pregnant women who needed to start dialysis with different schedules in a public hospital in Mexico City, with particular attention on the interference of social and cultural elements as well as resource limitations. Material and methods: CKD women who needed dialysis in pregnancy over the per...
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#2Elena ZakharovaH-Index: 6
Last. Adeera LevinH-Index: 67
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Pregnancy is possible in all phases of chronic kidney disease (CKD), but its management may be difficult and the outcomes are not the same as in the overall population. The prevalence of CKD in pregnancy is estimated at about 3%, as high as that of pre-eclampsia (PE), a better-acknowledged risk for adverse pregnancy outcomes. When CKD is known, pregnancy should be considered as high risk and followed accordingly; furthermore, since CKD is often asymptomatic, pregnant women should be screened for...
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