Chronic dialysis

Question 0

Pregnancy outcome

Answer 0

21% miscarry within the second trimester 
PTL is common
Mean gestational age is 32 weeks
Premature death contribute to low infant survival rate of 30-50%
Polyhydramnios 42-79%
Maternal complications:
Hypertensive crisis
PET
anaemia
Abruption

Half of the Women will be delivered by Caesarean section

Question 1

Incidence

Answer 1

1-7%
More likely in women on long term dialysis than those who have just started
More likely in heamodialysis than peritoneal one

Question 2

Management

Answer 2

Protein intake to be increased to 1.5/1.8g/kg/day.
Fluid intake individualised depending on usual input/output and frequency of replacement therapy
Calcium requirement is 1.5 g/day so
They need calcium dialysate and vit D
Measurament each trimester
Also Folic acid 5 mg, vit c, thiamine, riboflavin niacin and bit b6

Question 3

Dialysis

Answer 3

Can be continued in pregnancy
Increase number of sessions
It may be impossible to continue peritoneal dialysis as uterus enlarges an therefore switch to heamodialysis
No increased incidence of peritonitis
Caesarean section must be performed extraperitoneally