Frequency and Outcome of Pregnancy in Women after Commencing Maintenance Hemodialysis in Sub-Saharan Africa: An Observation from a Single Center

Gloria Ashuntantang Enow, Hermine Ebana Fouda, Jean Dupont N Kemfang, Maimouna Mahamat, Alex T Mambap, Alain P Menanga, Francois F Kaze

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.

 


Keywords


Pregnancy, maintenance haemodialysis, sub-Saharan Africa

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