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Abstract
Background: Improved dialysis care and adequate healthcare resources, have led to better pregnancy outcomes in hemodialysis-dependent women of the middle and high-income countries. This study aimed to describe the frequency and outcome of pregnancy in women on maintenance hemodialysis at a hemodialysis center in Cameroon over a period of 11years.
Methods: We conducted a retrospective study of medical records of all women who became pregnant after commencing maintenance hemodialysis at the Yaounde General Hospital November 2002 to 31st December 2013. Patient and pregnancy data were collected and analyzed.
Results: During the study period of 11 years, six pregnancies occurred in four (4.8%) of 84 women aged between 14-44 years giving a cumulative incidence of 7.14%. All pregnancies were unplanned and unexpected. The mean age of pregnant women was 30 ±5.47 years, mean dialysis vintage 39.5±26.24 months, and the mean gestational age at diagnosis of pregnancy was 15.8± 4.02 weeks. Three of the pregnancies occurred in anuric women, while 5 of the pregnancies occurred in women with regular menstruation. The pregnancies resulted in 4 (66.7%) spontaneous abortions (12, 16 and 19 weeks), one (16.7%) elective abortion (14 weeks), and one (16.7%) live preterm birth at 34 weeks gestation.
Conclusion: Pregnancy is rare but possible in dialysis-dependent women receiving suboptimal hemodialysis care. The high frequency of unplanned pregnancies observed, calls for the inclusion of preconception counseling in the care package of young ESRD women in resource-limited settings.
Résumé :
Contexte : L’amélioration des soins de dialyse dans les pays industrialisés a révolutionné le pronostic des grossesses des hémodialysées chroniques. L'objectif était de décrire la fréquence et l'issue des grossesses des femmes hémodialysées chroniques dans un centre d’hémodialyse au Cameroun sur une période de onze années.
Méthode : De novembre 2002 au 31 décembre 2013, nous avons conduit une étude rétrospective chez les hémodialysées chroniques en âge de procréer à l’Hôpital Général de Yaoundé afin d’évaluer la survenue de grossesses après la mise en hémodialyse.
Résultats : Durant la période d’étude, 6 grossesses ont été enregistrées chez 4(4,8%) des 84 femmes âgées de 14-44 ans, soit une incidence cumulative de 7,14%. Toutes les grossesses étaient non désirées et non planifiées. L’âge moyen des femmes était de 30 ± 5,47 ans. La durée moyenne en dialyse était de 39,5 ± 26,4 mois. L’âge gestationnel moyen au diagnostic de grossesse était de 15,8 ± 4,02 semaines. Trois grossesses ont été notées chez des patientes anuriques, et 05 grossesses étaient chez les femmes ayant des cycles menstruels réguliers. Les grossesses ont abouti à 04(66,7%) avortements spontanés (12, 16,19semaines), 01(16,7%) interruption médicale de grossesse (14semaines), et 01(16,7%) accouchement prématuré à 34 semaines avec un bébé vivant.
Conclusion : Les grossesses sont rares mais possibles chez les hémodialysées chroniques dans les pays a ressources limitées. La fréquence élevée des grossesses non désirées exige l'introduction de la consultation préconceptionelle dans la prise en charge des jeunes hémodialysées dans nos régions.
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References
- References
- Successful pregnancies in women treated by dialysis and kidney transplantation. Report from the Registration Committee of the European Dialysis and Transplant Association. Br J Obstet Gynaecol. 1980 Oct;87(10):839–45.
- Hou SH. Frequency and outcome of pregnancy in women on dialysis. Am J Kidney Dis. 1994;23(1):60–3.
- Bagon J, Vernaeve H, De Muylder X, Lafontaine J, Martens J, Van Roost G. Pregnancy and dialysis. Am J Kidney Dis. 1998 mai;31(5):756–65.
- Toma H, Tanabe K, Tokumoto T, Kobayashi C, Yagisawa T. Pregnancy in women receiving renal dialysis or transplantation in Japan: a nationwide survey. Nephrol Dial Transplant. 1999 Jun 1;14(6):1511–6.
- Nadeau-Fredette A-C, Hladunewich M, Hui D, Keunen J, Chan CT. End-Stage Renal Disease and Pregnancy. Adv Chronic Kidney Dis. 2013;20(3):246–52.
- Holley JL, Schmidt RJ, Bender FH, Dumler F, Schiff M. Gynecologic and reproductive issues in women on dialysis. Am J Kidney Dis. 1997;29(5):685–90.
- Lew SQ, Patel SS. Psychosocial and quality of life issues in women with end-stage renal disease. Adv Chronic Kidney Dis. 2007;14(4):358–63.
- Palmer BF. Sexual dysfunction in uremia. J Am Soc Nephrol. 1999;10(6):1381–8.
- Thompson S, Marnoch CA, Habib S, Robinson H, Pauly RP. A successful term pregnancy using in-center intensive quotidian hemodialysis. Hemodial Int. 2011;15(S1):S59–S63.
- Haase M, Morgera S, Bamberg C, Halle H, Martini S, Hocher B, et al. A systematic approach to managing pregnant dialysis patients—the importance of an intensified haemodiafiltration protocol. Nephrol Dial Transplant. 2005 Nov 1;20(11):2537–42.
- Shahir AK, Briggs N, Katsoulis J, Levidiotis V. An observational outcomes study from 1966–2008, examining pregnancy and neonatal outcomes from dialysed women using data from the ANZDATA Registry. Nephrology. 2013;18(4):276–84.
- Hou S. Editorial Focus: Dialysis and Pregnancy: Pregnancy in Dialysis Patients: Where Do We Go From Here? Semin Dial. 2003;16(5):376–8.
- Vázquez Rodríguez JG. Hemodialysis and pregnancy: technical aspects. Cir Ciruj. 2010;78(1):93–6.
- Reddy SS, Holley JL. Management of the pregnant chronic dialysis patient. Adv Chronic Kidney Dis. 2007;14(2):146–55.
- Hou S. Modification of dialysis regimens for pregnancy. Int J Artif Organs. 2002 Sep;25(9):823–6.
- Bamberg C, Diekmann F, Haase M, Budde K, Hocher B, Halle H, et al. Pregnancy on Intensified Hemodialysis: Fetal Surveillance and Perinatal Outcome. Fetal Diagn Ther. 2007;22(4):289–93.
- Barua M, Hladunewich M, Keunen J, Pierratos A, McFarlane P, Sood M, et al. Successful Pregnancies on Nocturnal Home Hemodialysis. Clin J Am Soc Nephrol. 2008 Mar 1;3(2):392–6.
- Eroğlu D, Lembet A, Özdemir FN, Ergin T, Kazancı F, Kuşcu E, et al. Pregnancy during hemodialysis: perinatal outcome in our cases. Transplant Proc. 2004 Jan;36(1):53–5.
- Naicker S. End-stage renal disease in Sub-Saharan Africa. Kidney Int Suppl. 2013 May;3(2):161–3.
- Sambo LG, Kirigia JM, Ki-Zerbo G. Health financing in Africa: overview of a dialogue among high level policy makers. BMC Proc. 2011 Jun 13;5(Suppl 5):S2.
- Swanepoel CR, Wearne N, Okpechi IG. Nephrology in Africa—not yet uhuru. Nat Rev Nephrol. 2013;9(10):610–22.
- Raharivelina CA, Randriamanantsoa LN, Rabenantoandro R. Hémodialyse chronique et grossesse. Médecine Afr Noire. 51(1):27–30.
- Jesudason S, Grace BS, McDonald SP. Pregnancy Outcomes According to Dialysis Commencing Before or After Conception in Women with ESRD. Clin J Am Soc Nephrol CJASN. 2013 Nov 14;
- Hladunewich M, Hercz AE, Keunen J, Chan C, Pierratos A. Pregnancy in end stage renal disease. Semin Dial. 2011 Dec;24(6):634–9.
- Luders C, Martins Castro MC, Titan SM, De Castro I, Elias RM, Abensur H, et al. Obstetric Outcome in Pregnant Women on Long-term Dialysis: A Case Series. Am J Kidney Dis. 2010 juillet;56(1):77–85.
- Chao A-S, Huang J-Y, Lien R, Kung F-T, Chen P-J, Hsieh PCC. Pregnancy in women who undergo long-term hemodialysis. Am J Obstet Gynecol. 2002 Jul;187(1):152–6.
- Piccoli GB, Conijn A, Consiglio V, Vasario E, Attini R, Deagostini MC, et al. Pregnancy in dialysis patients: is the evidence strong enough to lead us to change our counseling policy? Clin J Am Soc Nephrol. 2010;5(1):62–71.
- Souqiyyeh MZ, Huraib SO, Saleh AG, Aswad S. Pregnancy in chronic hemodialysis patients in the Kingdom of Saudi Arabia. Am J Kidney Dis Off J Natl Kidney Found. 1992;19(3):235.
- Bahloul H, Kammoun K, Kharrat M, Jarraya F, Charffedine K, Hamida MB, et al. Pregnancy in chronic hemodialysis women: outcome of multicentric study. Saudi J Kidney Dis Transplant Off Publ Saudi Cent Organ Transplant Saudi Arab. 2003 Dec;14(4):530–1.
- Malik GH, Al-Wakeel JS, Shaikh JF, Al-Mohaya S, Dohami H, Kechrid M, et al. Three successive pregnancies in a patient on haemodialysis. Nephrol Dial Transplant. 1997;12(9):1991–3.
References
References
Successful pregnancies in women treated by dialysis and kidney transplantation. Report from the Registration Committee of the European Dialysis and Transplant Association. Br J Obstet Gynaecol. 1980 Oct;87(10):839–45.
Hou SH. Frequency and outcome of pregnancy in women on dialysis. Am J Kidney Dis. 1994;23(1):60–3.
Bagon J, Vernaeve H, De Muylder X, Lafontaine J, Martens J, Van Roost G. Pregnancy and dialysis. Am J Kidney Dis. 1998 mai;31(5):756–65.
Toma H, Tanabe K, Tokumoto T, Kobayashi C, Yagisawa T. Pregnancy in women receiving renal dialysis or transplantation in Japan: a nationwide survey. Nephrol Dial Transplant. 1999 Jun 1;14(6):1511–6.
Nadeau-Fredette A-C, Hladunewich M, Hui D, Keunen J, Chan CT. End-Stage Renal Disease and Pregnancy. Adv Chronic Kidney Dis. 2013;20(3):246–52.
Holley JL, Schmidt RJ, Bender FH, Dumler F, Schiff M. Gynecologic and reproductive issues in women on dialysis. Am J Kidney Dis. 1997;29(5):685–90.
Lew SQ, Patel SS. Psychosocial and quality of life issues in women with end-stage renal disease. Adv Chronic Kidney Dis. 2007;14(4):358–63.
Palmer BF. Sexual dysfunction in uremia. J Am Soc Nephrol. 1999;10(6):1381–8.
Thompson S, Marnoch CA, Habib S, Robinson H, Pauly RP. A successful term pregnancy using in-center intensive quotidian hemodialysis. Hemodial Int. 2011;15(S1):S59–S63.
Haase M, Morgera S, Bamberg C, Halle H, Martini S, Hocher B, et al. A systematic approach to managing pregnant dialysis patients—the importance of an intensified haemodiafiltration protocol. Nephrol Dial Transplant. 2005 Nov 1;20(11):2537–42.
Shahir AK, Briggs N, Katsoulis J, Levidiotis V. An observational outcomes study from 1966–2008, examining pregnancy and neonatal outcomes from dialysed women using data from the ANZDATA Registry. Nephrology. 2013;18(4):276–84.
Hou S. Editorial Focus: Dialysis and Pregnancy: Pregnancy in Dialysis Patients: Where Do We Go From Here? Semin Dial. 2003;16(5):376–8.
Vázquez Rodríguez JG. Hemodialysis and pregnancy: technical aspects. Cir Ciruj. 2010;78(1):93–6.
Reddy SS, Holley JL. Management of the pregnant chronic dialysis patient. Adv Chronic Kidney Dis. 2007;14(2):146–55.
Hou S. Modification of dialysis regimens for pregnancy. Int J Artif Organs. 2002 Sep;25(9):823–6.
Bamberg C, Diekmann F, Haase M, Budde K, Hocher B, Halle H, et al. Pregnancy on Intensified Hemodialysis: Fetal Surveillance and Perinatal Outcome. Fetal Diagn Ther. 2007;22(4):289–93.
Barua M, Hladunewich M, Keunen J, Pierratos A, McFarlane P, Sood M, et al. Successful Pregnancies on Nocturnal Home Hemodialysis. Clin J Am Soc Nephrol. 2008 Mar 1;3(2):392–6.
Eroğlu D, Lembet A, Özdemir FN, Ergin T, Kazancı F, Kuşcu E, et al. Pregnancy during hemodialysis: perinatal outcome in our cases. Transplant Proc. 2004 Jan;36(1):53–5.
Naicker S. End-stage renal disease in Sub-Saharan Africa. Kidney Int Suppl. 2013 May;3(2):161–3.
Sambo LG, Kirigia JM, Ki-Zerbo G. Health financing in Africa: overview of a dialogue among high level policy makers. BMC Proc. 2011 Jun 13;5(Suppl 5):S2.
Swanepoel CR, Wearne N, Okpechi IG. Nephrology in Africa—not yet uhuru. Nat Rev Nephrol. 2013;9(10):610–22.
Raharivelina CA, Randriamanantsoa LN, Rabenantoandro R. Hémodialyse chronique et grossesse. Médecine Afr Noire. 51(1):27–30.
Jesudason S, Grace BS, McDonald SP. Pregnancy Outcomes According to Dialysis Commencing Before or After Conception in Women with ESRD. Clin J Am Soc Nephrol CJASN. 2013 Nov 14;
Hladunewich M, Hercz AE, Keunen J, Chan C, Pierratos A. Pregnancy in end stage renal disease. Semin Dial. 2011 Dec;24(6):634–9.
Luders C, Martins Castro MC, Titan SM, De Castro I, Elias RM, Abensur H, et al. Obstetric Outcome in Pregnant Women on Long-term Dialysis: A Case Series. Am J Kidney Dis. 2010 juillet;56(1):77–85.
Chao A-S, Huang J-Y, Lien R, Kung F-T, Chen P-J, Hsieh PCC. Pregnancy in women who undergo long-term hemodialysis. Am J Obstet Gynecol. 2002 Jul;187(1):152–6.
Piccoli GB, Conijn A, Consiglio V, Vasario E, Attini R, Deagostini MC, et al. Pregnancy in dialysis patients: is the evidence strong enough to lead us to change our counseling policy? Clin J Am Soc Nephrol. 2010;5(1):62–71.
Souqiyyeh MZ, Huraib SO, Saleh AG, Aswad S. Pregnancy in chronic hemodialysis patients in the Kingdom of Saudi Arabia. Am J Kidney Dis Off J Natl Kidney Found. 1992;19(3):235.
Bahloul H, Kammoun K, Kharrat M, Jarraya F, Charffedine K, Hamida MB, et al. Pregnancy in chronic hemodialysis women: outcome of multicentric study. Saudi J Kidney Dis Transplant Off Publ Saudi Cent Organ Transplant Saudi Arab. 2003 Dec;14(4):530–1.
Malik GH, Al-Wakeel JS, Shaikh JF, Al-Mohaya S, Dohami H, Kechrid M, et al. Three successive pregnancies in a patient on haemodialysis. Nephrol Dial Transplant. 1997;12(9):1991–3.