This is a 31-year-old patient who since November 2006 has been undergoing a renal replacement therapy for hereditary chronic renal failure.
She had a temporary catheter in the left femoral artery that was later replaced by a permanent catheter in the right jugular vein.
You become pregnant, despite the reduced chance of fertility.
She was diagnosed by blood test, the date of her last rule was 1/1/2007 and the probable delivery date was 2/11/2007.
After the orientation of the nephrologist providing information about the situation and risks of his new condition, he decided to continue with his pregnancy.
The patient had anemia, which was corrected by increasing the dose of EPO, starting at 2,000 i.u. once a week and ending at 10,000 i.u.
3 times a week.
After delivery, EPO 30,000 i.u. was administered.
3 times a week.
There are no publications on the adverse effects of EPO in pregnancy, usually 50-100% of the dose is increased during pregnancy.
Ferremia and ferritin levels usually decrease, and iron deficiency may be the cause of anemia in the final stages of pregnancy.
There are doubts about the acute toxicity of iron in the foetus, so it is recommended to minimize the daily dose.
Folic acid is necessary for increasing maternal hematopoiesis and for proper maturation of the fetal neural tube.
In our case, iron was administered once a week.
The benefit of daily or intensive hemodialysis in pregnancy has been suggested on many occasions, but its value to improve the results of pregnancies is not defined yet, although there are theoretical reasons to support its use accumulated placental insufficiency even lower volume.
We increased the frequency of dialysis metrorrhagia; the heparinization regimen was maintained throughout pregnancy until the patient developed bleeding and was stopped thereafter.
Heparin does not attack the placental barrier and is not teratogenic, which makes it safe and is indicated, if there is no contraindication, at usual doses to prevent clotting of the placenta.
The pregnancy parameters were consulted with the obstetrics team of the Hospital Comarcal de Melilla and with the high risk obstetrics teams of the Hospital Infantil de Málaga.
1.
Dialysis scheme
Hemodialysis regime was changed from 4 hours 3 times a week to 3:30 hours sessions, resting on the feet and domingos, and then to 3:30 hours sessions.
The dialyzer was the same throughout pregnancy: Arylane M9® hollow fiber poliarileters used.
The dialysis bath was composed of bicarbonate, calcium 30 and the bathing flow of 500 ml/min. The blood flow oscillated depending on the type of catheter, bearing in mind that first had a temporary catheter gap between 200 mL and 300 mL.
1.
Incidences during pregnancy
Epistaxis reported. • Bleeding threatened with abortion at week 11. • Bleeding through the vagina in July and August without apparent cause and requiring coagulation during the last month regular discharge
At 31 weeks of gestation, the patient gave birth to a girl with a correct percentile and morphology and weight of 2,000 kg.
Therefore, we consider that the therapeutic scheme and the nursing care provided to the patient were adequate, contributing to the successful completion of pregnancy.
