| Abstract: |
This article presents the case of pregnancy and successful full-term delivery of a 32-year-old woman on peritoneal dialysis due to chronic tubulointerstitial nephritis secondary to vesicoureteral reflux. The patient already had a functioning arteriovenous fistula (AVF), which was created before she was started on continuous ambulatory peritoneal dialysis (CAPD). The patient’s pregnancy was discovered when she was 10 weeks pregnant; the patient, her partner, and physicians agreed that the pregnancy would continue with the patient on CAPD for as long as possible under close supervision and would change to hemodialysis (HD) if the need arose. The authors describe the patient’s care throughout the pregnancy, including the monitoring while hospitalized in the nephrology ward from the 28th week to the end of her pregnancy. Topics include the patient’s weight changes, erythropoietin requirements, medications, delivery, postdelivery management, and care of the newborn. The authors conclude with a discussion of this case and a review of the related literature. They stress that this article was not written to encourage patients with end-stage renal disease (ESRD) to become pregnant, which is still a risky undertaking; rather, to emphasize that if the parents very strongly desire a child or if the pregnancy is accidental but the patient wants to continue to term, a pregnancy can be managed effectively. 4 figures. 45 references. |