The first reported case of successful pregnancy in a haemodialysis patient in Yemen

Khalid H. Al-Wadei, Nagib W. Abu-Asba and Ahmed F. Donia

Nephrology department Al-Thawra general hospital Sanaa-Yemen Email: afdonia{at}hotmail.com

Sir,

Advances in dialysis, as well as in obstetric and neonatal treatment, have led to an improved success rate of pregnancy on maintenance dialysis [1]. Here, we report on the first woman with successful pregnancy on long-term haemodialysis treatment in Yemen.

Case. This is a 38-year-old female on haemodialysis for 10 years. She is a 10th gravida with eight living offspring. The patient did not use any method of contraception throughout her life. The eighth pregnancy started just before commencement of dialysis and ended as intrauterine fetal death. The patient remained amenorrheic on dialysis for 2 years. During the third year, the patient started to menstruate and the nineth pregnancy occurred. It ended as premature labour and neonatal death, and then regular menstruation resumed. Six years later, the 10th pregnancy occurred. During the sixth month of gestation, she complained of abdominal distension and pregnancy was ultrasonographically diagnosed. The dose of dialysis and amount of protein intake remained the same due to socioeconomic reasons. Her serum albumin ranged between 3 and 3.4 g/dl. The patient received erythropoietin and her haemoglobin ranged between 11 and 12 g/dl. She remained normotensive. During the eighth month of gestation, pre-term vaginal delivery of a viable premature baby weighing 2.3 kg occurred. The issue of contraception was discussed with the patient and tubal ligation was decided.

Comment. Birth control should be a vital point in management of haemodialysis women in their childbearing period. Additionally, menstrual history and symptoms of early pregnancy should be part of routine follow-up in these patients. The possibility of regaining menses after a prolonged period of amenorrhea must be considered while regularly evaluating these patients as this will increase the potential risk of pregnancy. On the other hand, the differential of diagnosis, dysfunctional uterine bleeding, must be considered, as well as endometrial cancer [2]. Finally, continued nephrologist–gynecologist collaboration is essential for proper care of women on intermittent dialysis treatment.

Conflict of interest statement. None declared.

References

  1. Chao AS, Huang JY, Lien R, Kung FT, Chen PJ, Hseih PC. Pregnancy in women who undergo long-term hemodialysis. Am J Obstet Gynecol 2002;187: 152–156[CrossRef][ISI][Medline]
  2. Grossman S, Hou S. Obstetrics and gynecology. In: Dougirdas JT, Blake PG, Todd SI, eds. Handbook of dialysis. Lippincott Williams & Wilkins, Philadelphia, 2001; 624–636




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