Case reports of pregnancies complicated with kidney disease and their fetal prognosis
The number of patients with chronic kidney disease (CKD) has been increasing every year, with a current prevalence of one in eight adults. Although the frequency of complications due to kidney disease before pregnancy is not high (0.02–0.12%), frequency of pregnancy with CKD, including cases receiving continuous dialysis therapy is expected to increase in the future. The fertility and birth rates among dialysis patients are low, and perinatal management in these patients is currently difficult. However, even under such circumstances, the probability of having a live-born baby in pregnant women on dialysis has increased due to improvements in dialysis technology, perinatal management, and neonatal care. There are some case reports written about them, and I think that it is possible to approach term delivery with careful care through the cases experienced this time. In this study, we examined the pregnant patients, on dialysis or requiring postpartum dialysis, at Kawasaki Medical School Hospital between January 2005 and March 2018. Six patients (86%) had a live-born baby, while one had a miscarriage. One patient underwent two pregnancies on dialysis; one case gave a full-term birth, while the rest had a premature delivery. The modes of delivery were vaginal delivery (n = 1), elective cesarean section (n = 3), and emergency cesarean section (n = 2). Five patients delivered successfully and had a good prognosis, while in one case, the neonate died. Over the years, owing to continuous improvement at our hospital, we have achieved better pregnancy prognosis and longer gestation periods in the patients. In particular, one case, which had a natural second pregnancy, 9 years after the beginning of dialysis, was worthy of note; we were able to manage her second pregnancy using the process followed during her first pregnancy as reference.
