Baillière's clinical obstetrics and gynaecology
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Baillieres Clin Obstet Gynaecol · Jun 1994
ReviewPregnancy in women on haemodialysis and peritoneal dialysis.
Pregnancy in women with renal insufficiency and end-stage renal disease, while uncommon, is definitely possible, and such women should not assume they are infertile. Contraception should be prescribed for those who do not want to conceive. For the woman who is dialysed during pregnancy, the risks can be minimized by aggressive blood pressure control and prompt diagnosis and treatment of bleeding episodes; however, no degree of vigilance can guarantee that a woman will not suffer any of the severe complications that have been described in pregnant dialysis patients. ⋯ While transplantation offers the best chance of child bearing for women with end-stage renal disease, transplantation is not always possible. Thus we no longer discourage women on dialysis from becoming pregnant as long as they understand that the likelihood of success is small and that serious risks are involved, and as long as they are willing to follow the time-consuming regimen we think it is necessary for their safety. We hope that, in time, increased experience with pregnant dialysis patients will lead to more successful outcomes and that the possibility of parenthood will be added to the improved quality of life in these women.
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Urinary infections, with a spectrum from covert bacteriuria to severe pyelonephritis, commonly complicate pregnancy. Serious infections follow untreated silent bacteriuria in a fourth of cases, and routine screening can be justified in high-risk populations, particularly in those women from lower socioeconomic strata. Despite an initial salutary response to a number of antimicrobial regimens, covert bacteriuria recurs in one-third of treated women whose risk of pyelonephritis again is at 25%. ⋯ Perhaps 20% of women with severe pyelonephritis develop complications that include septic shock syndrome or its presumed variants. These latter include renal dysfunction, haemolysis and thrombocytopenia, and pulmonary capillary injury. In most of these women, continued fluid and antimicrobial therapy result in a salutary outcome, but there is occasional maternal morbidity.