对于患有肾脏疾病的女性而言，怀孕是一个让人非常难为的事情。
很多时候，医生建议不要怀孕，但是传宗接代等压力还是让她们走上一条危险的道路。
更有甚者，直到怀孕了才突然发现自己的肾脏出了问题，这个更是悲剧中的悲剧。
在国内，几乎没有哪个透析中心愿意让患者在一边透析的同时一边怀孕。
是几乎没有，但不是绝对没有。
我想如果有相关的报道，对于这类人群的临床特征及预后以及注意事项等进行一些统计、分析，肯定能对我们的工作起到很大的帮助作用。
来自CJASN的一篇Article
Clin J Am Soc Nephrol 9: 143–149, 2014. doi: 10.2215/CJN.03560413
Pregnancy Outcomes According to Dialysis Commencing Before or After Conception in Women with ESRD
Summary
Background and objectives Pregnancy in ESRD is rare and poses substantial risk formother and baby. This study describes a large series of pregnancies in women undergoing long-term dialysis treatment and reviews maternal and fetal outcomes. Specifically, women who had conceived before and after starting long-term dialysis are compared.
ESRD患者妊娠的情况比较少见，且这种情况对母婴安全具有潜在风险； 本研究回顾了接受长期透析治疗的女患者的妊娠情况，分析了母亲和胎儿的预后。特别比较了妊娠前开始透析或妊娠后开始透析这两种情况的预后差异。
Design, setting, participants, & measurement All pregnancies reported to the Australian and New Zealand Dialysis and Transplantation Registry from2001 to 2011 (n=77), following the introduction of specific parenthood data collection, were analyzed.
数据收集了从2001年至2011年，澳大利亚/新西兰透析移植登记系统有妊娠记录的长期透析患者，并分析了母子相关数据。
Results Between 2001 and 2011, there were 77 pregnancies among 73 women. Of these, 53 pregnancies were in women who conceived after long-term dialysis was established and 24 pregnancies occurred before dialysis began. The overall live birth rate (after exclusion of elective terminations) was 73%. In pregnancies reaching 20 weeks gestation, the live birth ratewas 82%.Womenwho conceived before dialysis commenced had significantly higher live birth rates (91% versus 63%; P=0.03), but infants had similar birthweight and gestational age. This difference in live birth rate was primarily due to higher rates of early pregnancy loss before 20 weeks in women who conceived after dialysis was established. In pregnancies that reached 20 weeks or more, the live birth rate was higher in women with conception before dialysis commenced (91% versus 76%; P=0.28). Overall, the median gestational age was 33.8weeks (interquartile range, 30.6–37.6weeks) andmedian birthweightwas 1750 g(interquartile range, 1130–2417g). More than 40% of pregnancies reached .34 weeks’ gestation; prematurity at ,28 weeks was 11.4% and 28-day neonatal survival rate was 98%.
研究期间共记录到73位女性患者77例次妊娠事件。其中，53例次妊娠发生在开始透析之后，24例次妊娠发生在开始透析之前； 排除择期终止妊娠者，总体活产率为73%。妊娠期达到20周以上者，活产率达82%； 妊娠后开始透析的女性患者活产率显著高于妊娠前开始透析者（91% vs 63%； p=0.03），婴儿的出生体重和孕龄则相似； 总体中位数孕龄为33.8周，中位数出生婴儿体重为1750g。超过40%的妊娠达到34周孕龄以上。小于28周的早产比例达11.4%，28天新生儿存活率达98%
Conclusions Women with kidney disease who start long-term dialysis after conception have superior live birth rates compared with those already established on dialysis at the time of conception, although these pregnancies remain high risk.
尽管处于高风险状态，妊娠后开始透析的ESRD女性患者活产率高于妊娠前开始透析者。
http://e.dxy.cn/Baxtermedical/node/1224
百特肾科医学频道，Current Awareness - Mar - 2014
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Pregnancy outcomes according to dialysis commencing before or after conception in women with ESRD.pdf(630.26k) |
