Dialyse und Schwangerschaft – Eine Fallserie von fünf Schwangeren unter intensivierter Dialyse

Dialysepflichtige Frauen werden selten schwanger. Fallberichte geben das fetale Outcome mit einer Lebendgeburtenrate zwischen 40 und 85 % an. Wir berichten von fünf dialysepflichtigen Schwangeren, die an unserem Perinatalzentrum betreut wurden. Alle Patientinnen erhielten ein standardisiertes, intensiviertes Dialyseprotokoll mit bis zu 7 Hämodiafiltrationen pro Woche mit einer mittleren Behandlungszeit von 28,6 ± 6,3 Stunden pro Woche. Der Behandlung lag ein multidisziplinärer Betreuungsansatz in Kooperation mit den Nephrologen und Neonatologen zugrunde. Supportiv erhielten die Patientinnen Erythropoetin, Vitamine und Spurenelemente. Ab der 26. Schwangerschaftswoche wurden alle Patientinnen stationär überwacht. Das mittlere Gestationsalter bei der Entbindung betrug 32,8 ± 3,3 Schwangerschaftswochen und die Neugeborenen waren im Mittel 1765 ± 554 g schwer. Die Lebendgeburtenrate betrug 100 %. Das fetale Outcome profitiert von einer qualifizierten, multidisziplinären Betreuung am Perinatalzentrum. Bei dialysepflichtigen Schwangeren sollte die Dialysedauer intensiviert werden und eine stationäre Betreuung im 2. Trimenon stattfinden.

Women subject to dialysis are rarely pregnant. Case reports have registered a fetal outcome of between 40 and 85 per cent live births. This is a report on five pregnant women subject to dialysis treated in our perinatal center. All these patients were subjected to a standardized intensified dialysis procedure with up to seven hemodiafiltrations weekly with an average treatment period of 28.6 +/– 6.3 hours weekly. A multidisciplinary care program was initiated in co–operation with the nephrologists and neonatologists. The patients supportingly received erythropoietin, vitamins and trace elements. Starting with the 26th week of pregnancy all patients were closely watched on an in–patient basis. The average gestation age at birth was +/– 3.3 pregnancy weeks and the average newborn weight was 1765 +/– 554 g. The live birth rate was 100 %. The fetal outcome benefited from a qualified multidisciplinary care program of the perinatal center. Pregnant women who are subjected to dialysis should be dialysed for a longer time and subjected to inpatient supervision from the second three–month term of pregnancy.

pregnancy - intensified hemodialysis - fetal surveillance - perinatal outcome

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