Gestación en paciente con tratamiento renal sustitutivo

Abstract

The frequency of pregnancy in women undergoing haemodialysis is low (between 0.3 and 0.75% of women of childbearing age)¹ . This fact is attributed to different hormonal factors, many of them anovulatory: hyperprolactinemia, ovarian dysfunction with anovulations, luteal insufficiency, decreased libido (due to alterations in the pulses of human chorionic gonadotropin), increased levels of leptin (due to decreased renal clearance), abnormalities of the ovarian pituitary axis2. When a case of pregnancy occurs in a patient with HD, regardless of the criteria followed, the prescription for haemodialysis must be sufficient to maintain stable maternal conditions in relation to circulating volume, blood pressure (= 140/80 to 90 mm Hg 7.8.10) and interdialytic weight gain. The prescription of ultrafiltration must be individualised to avoid episodes of hypovolaemia, arterial hypotension and maternal cardiac arrhythmia. It should be adjusted to respect the maternal weight gain and blood volume expansion corresponding to the time of gestation1. Metabolic disorders are one of the most difficult parts to manage. Ideal concentrations of haemoglobin and haematocrit range from 11-12 mg/dl and 33-36% respectively. Calcium, phosphorus and potassium should be controlled in the same way.