Emobileclinic Specialist Despite reduced libido and relative infertility ,women on dialysis can conceive but should use contraceptive if they wish to avoid pregnancy. Although contraception is not common -say 1 in 200 patients, its true frequency is unknown because most pregnancies in dialysis patients probably end in early spontaneous abortion; although the rate has dropped from 40% to 20%.
The high therapeutic abortion rate in this group of patients still suggests that those who become pregnant do so inadvertently, probably because they are unaware that pregnancy is possible. Many authorities do not advise conception or continuation of pregnancy if present when the woman has severe renal insufficiency. Pregnancy poses big risks for the mother who is prone to volume overload,major exacerbations of her hypertension or superimposed pre-eclampsia, with only a 40- 50% chance of a successful obstetrics outcome.
Management in pregnancy
Women on dialysis, if they become pregnant may likely present when the pregnancy is advanced because pregnancy was not suspected by either the patient or her doctor. This is because irregular menstruation is common in dialysis patients and missed periods are usually ignored. Urine pregnancy test are unreliable and test should be by ultrasound evaluation to confirm pregnancy. The following policies will help the patients in pregnancy ; -High blood pressure should be avoided during dialysis as this can cause damages to the fetus .In late pregnancy the enlarging uterus and the supine posture may aggravate this situation by decreasing venous return.The following should be ensured;
– weight gain should be limited to 1kg until late pregnancy. This can be achieved by avoiding fluctuations in intravascular volume.
– Ensure tight control of blood pressure throughout pregnancy.
– Plasma Surea is less than 20mmol/l as intrauterine fetal death is more likely if the values are much in excess of 20mmol/l
-dialysis patients are usually anemic, invariably aggravated further in pregnancy. Unnecessary blood sampling should be avoided in the face of anaemia and lack of venepuncture sites. Caution is needed as transfusion can exacerbate hypertension and impair the ability to control circulatory overload, even with extra dialysis. rHuEpo has been used in pregnancy without ill effects.
-Despite more frequent dialysis,an uncontrolled dietary intake should be discouraged. A daily oral intake of 70g protein,1500mg calcium,50mmol/l potassium and 80 mmol sodium is advised with supplements of dailysable vitamins and irons and folic acid supplements. Vitamin D supplements can be difficult to judge in patients who have had parathyroidectomy.All these pose risks to the fetal nutrition as well as the impact of a uraemic environment.
-Caesarean section should be necessary only for obstetrics reasons. Caesarean section in all cases would minimize potential problems during labour. – Peritoneal dialysis has shown successful management results in younger women reported pregnancies.
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