Pregnancy in chronic hemodialysis in a resource-limited country: case report and literature review

BACKGROUND: Conception in hemodialysis is a rare event with an incidence of 0.5-1.4% of women of childbearing age, and associated with a high maternal-fetal risk. We report a case of full-term pregnancy with live child that occurred in our hemodialysis center at Kayes Hospital in Mali. CASE PRESENTATION: The patient was 38 years old and had been on chronic hemodialysis for 4 years for hypertensive nephropathy. She was dialyzed twice a week for 8 h. We discovered a pregnancy of 17 weeks' amenorrhea (WA) in a context of acute pelvic pain. Hemodialysis was immediately intensified to 3 times/week for 4 h 30 min until 32 weeks' amenorrhea, then 4 times/week for 4 h 30 min until term. Thanks to blood pressure control, dry weight control and hemoglobin control at around 12 g/dl on erythropoietin, the pregnancy was carried to 36 SA + 6 days, with vaginal delivery resulting in a live infant weighing 2800 g. The newborn's renal function at 24 and 48 h was normal, with a mean hemoglobin level of 17 g/dl. CONCLUSION: Pregnancy in chronic hemodialysis is a very high-risk maternal and fetal condition. This first observation in Mali shows that procreation is possible for hemodialysis recipients despite limited resources. Multidisciplinary management, combined with blood pressure control, intensification of hemodialysis and correction of anemia, guarantee the best results.