Pregnancy in patients on maintenance hemodialysis: seven cases report and 169 reported cases review

Objective To analyze and summarize the cases of pregnancy on maintenance hemodialysis (MHD), and review the literature. Methods Seven cases of pregnancy and childbirth in patients on MHD in the First Affiliated Hospital of Zhejiang University from Jan 2009 to Dec 2017 were analyzed, and the literature about pregnancy in patients on MHD reported in Pubmed and Web of Science database was retrieved. Both maternal and fetal outcome were studied. Results There are seven pregnant MHD patients in this center, among whom six patients went through a smooth pregnancy and one patient had intra-uterine fetal death at 14 weeks of pregnancy. The six patients had preterm labor. Among six fetuses, four grew in good health and developed well, one had physical development retardation and one had heart malformation at born. In the literature, 169 cases reported pregnant patients and 182 fetuses were evaluated, of which 145 live infants were delivered, 79.67% overall fetal survival rate, with gestational age of (32.94±3.34) weeks. In 164 delivered fetuses, 147 were preterm labor (89.63%). The weight of live births was (1824±609) g. There were no maternal deaths. Fetal survival rate was zero in<20 weeks of gestational age, 20-24 weeks was 14.29%, 25-27 weeks was 45.45%, ≥28 weeks was 94.44%. The fetal survival rate was higher in pregnant woman receiving hemodialysis≥28 hours weekly compared to women receiving <16 hours weekly (92.31% vs 52.94%, P=0.02). Conclusions There are still a very high maternal and fetal complication rate in hemodialysis patients, especially in fetus. Gestational age≥28 weeks has a high fetal survival rate. Intensive dialysis during pregnancy may benefit higher fetal survival rate. Key words: Renal dialysis; Pregnancy outcome; Fetus; Review literature