Introduction:
For many years, in Uzbekistan, the quality of hemodialysis and coverage of the population with it was unsatisfactory. In recent years, large-scale reforms in medicine have been taking place in the country, in particular in the field of nephrology and hemodialysis. As a result of these efforts, the nephrology hemodialysis service is qualitatively improving in the country, including for women of fertile age.
Methods:
Patient A.F., 39 years old, with ESRD, applied to our center on June 14, 2023 with a detected pregnancy of 18 weeks.. She has been receiving hemodialysis sessions regularly for 9 years. History: she has been ill since the age of 22, when, during an examination by a nephrologist, chronic glomerulonephritis was discovered and diagnosed; no biopsy was performed. She was under the control of a nephrologist until 2009, when CKD developed. She was under the control of a nephrologist until ESRD developed in 2013, after which the patient was recommended RRT. Since March 12, 2013, she has been receiving HD in our center. Obstetric history - 1 term birth, without any peculiarities, and 1 medical abortion at 11-12 weeks. A few days ago, after experiencing nausea, vomiting, malaise and abdominal discomfort, she was sent for screening to determine if she was pregnant. Based on the results of two consecutive screenings pregnancy was detected, 18 weeks, without pathologies and with progression.
Results:
Patient categorically refused to terminate the pregnancy. Antianemic drugs and erythropoietin were used as drug therapy. At 29-30 weeks of pregnancy, she was admitted as planned to the pregnancy pathology department. During the examination: BP-100/60 mmHg, HR-80 beats per minute, daily diuresis 2.0-2.5 liters. CBC: Hb-81, erythrocytes-2.7, leukocytes-8.5, platelets-192, ESR-63. Urine: protein-0.3, leukocytes-15-20, epithelium-4-5, erythrocytes-1-2. Blood biochemistry: ALT-21, AST-21, alkaline phosphatase-84, total bilirubin-5, urea-6.9, creatinine-284, total protein-63, gamma glutamyl transpeptidase-9, homocysteine-11.77, vitamin B12- 903, folic acid-6.64, ferritin-2826.2, calcium-2.01, phosphorus 0.75, cholesterol-6.3, glucose-4.2, fibrinogen-5.02g/l. PTH-445.8 pg/ml, Vitamin D-10.2 ng/ml. Hormones: Chorionic gonadotropin-263240 mlU/ml, free estriol-2.82. Tests for HIV, hepatitis B, C, and TORCH infections showed negative results. ECG-sinus rhythm, heart rate - 82 beats per minute. Ultrasound revealed moderate hepatomegaly, chronic cholecystitis, bile stagnation and bilateral shrinkage of both kidneys.
Conclusions:
On 09/07/2023 at 09:00, the patient underwent a HD session, then at 14:45 the patient was transferred to the maternity ward, at 16:50, a live premature boy was born, weighing 1554 g, length 42 cm, with an Apgar score of 5/7 points. The child was sent to the pediatric intensive care unit. The mother continued to receive HD. After 5 days, she was discharged home. The child stayed in the neonatal pathology department. A premature newborn corresponds to a gestational age of 29 weeks. Incubator nursing, respiratory therapy NCPAP, treatment - Curasurf, antibacterial therapy (ampisul, merkacin) were carried out. After his condition improved, on September 20, 2022, he was safely discharged home to his mother. After 1 month, the mother’s condition is stable and the child is growing satisfactorily.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.