Pregnancy and Hemodialysis 27fetal outcomes, and the intensive dialysis dose must be adjusted according to
the maternal serum UN levels.
COMPLICATIONS
Here, major complications are described based on the previously
published reports on the topic. Overall, maternal hypertension is the most
commonly reported complication in patients on dialysis, occurring in 40-80%
of cases [7, 9, 11]. Preeclampsia is a severe condition associated with severe
hypertension. A report of available data from 67 patients on HD or peritoneal
dialysis in 1998 showed that 79% (n = 53) of women had some degree of
hypertension, while 48% (n = 32) had blood pressure higher than 170/110
mmHg, and 7% (n = 5) of patients required admission to the intensive care
unit for hypertensive crisis [7]. The rates of preeclampsia were 29% [18] and
67% [19] in studies reported in 2004 and 2005, respectively. In addition, a
study conducted from 1966 to 2008 in Australia and New Zealand showed
that, out of a total of 49 pregnancies and 30 live births, 19.4% of women
developed preeclampsia [20]. Intensive dialysis treatment is likely to result in
a lower risk of maternal hypertension, because a daily HD schedule helps
avoid fluid overload between dialysis sessions, leading to better control of
hypertension. The results of patients treated with intensive dialysis at least 6
times per week, with a mean dialysis time of 28.6 ± 6.3 hours per week,
showed that the rate of severe hypertension was 40%, [11] and the mean blood
pressure remained within the normal range, although 33% of pregnancies
required antihypertensive medications [12].
Preterm delivery is another frequent complication. One previous report
[14] described that every effort should be made to prolong pregnancy as much
as possible in cases in which viability was possible but the risk of long-term
problems was very high (“extremely preterm period;” 24-28 weeks) [21, 22],
while delivery after the 34th completed gestational week is especially
desirable, on account of the important reduction in major fetal risks after this
term (the “late preterm period,” defined as 34-37 gestational weeks) [21-24].
As described above, the neonatal outcomes are significantly worse before 32
weeks of gestational age, and to reach a delivery at over 32 gestational weeks
is hence important [10]. In the 1990s and early 2000s, most outcomes of
women who went into labor at an average gestational age of less than 34
weeks were not satisfactory, even though live births were generally obtained
[6-9, 11, 17-19, 25]. In the second half of the 2000s and beyond, along with