P118
A SUCCESSFUL MULTIDISCIPLINARY APPROACH LEADING TO IMPROVED
PREGNANCY OUTCOME IN A YOUNG HAEMODIALYSIS PATIENT
Fitzgerald, Z, Ashworth, V, Morgan, H, Walkinshaw, S, Alexander, J
1
Renal Unit, Royal Liverpool University Hospital, 2Liverpool Women’s Hospital
INTRODUCTION: A successful pregnancy is a rare outcome in chronic haemodialysis
patients. Pregnancy complications include premature delivery, intrauterine growth retardation,
maternal hypertension and polyhydramnios. Reports suggest that longer dialysis hours,
particularly daily nocturnal haemodialysis, improves pregnancy outcome. We present two
pregnancies in the same haemodialysis patient, the first resulting in neonatal death and a
second resulting in a baby girl.
CASE PRESENTATION: The patient developed end stage renal disease due to Cystinosis.
She commenced haemodialysis at 11 years old and underwent a cadaveric renal transplant
two years later. Her transplant failed after 4 years, hence she recommenced haemodialysis in
2000.
1st Pregnancy: In Nov 2004, she presented after two months amenorrhoea and
ultrasonography confirmed a 3 month pregnant uterus. Her HD prescription was switched to 3
hours six days/ week. At 24 weeks gestation, she presented with vaginal bleeding and went on
to deliver a male infant, who died after 12 hours from a cerebral haemorrhage.
Post pregnancy she was diagnosed with a non ischaemic Cardiomyopathy, treated with ACE
inhibition, beta-blockade and digoxin.
2nd Pregnancy: In May 2011 a positive pregnancy test was again obtained and after
counselling, she decided to proceed with the pregnancy. We discontinued potentially harmful
drugs, sought early obstetric review and initially increased her dialysis time to 3 hours six
days/week for 10 weeks. Thereafter we provided 6 hours HD six days/ week for a further 13
weeks. This pregnancy was complicated by placenta praevia and several episodes of vaginal
bleeding. At 30 + 4 weeks gestation, a 1.65 kg baby girl was delivered by emergency
caesarean section. The baby was discharged from hospital after seven weeks. The patient
continues on maintenance HD and her baby girl is developing well.
CONCLUSION: The delivery of increased dialysis hours, up to 36 hours/week in the second
and third trimesters of the 2nd pregnancy compared with 18 hours/week in the 1st pregnancy, is
likely to have contributed to the improved outcome. Careful monitoring by the renal and
obstetric teams and communication between teams also made an important contribution.