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  • Title: Pregnancy and birth control in CAPD patients.
    Author: Hou S.
    Journal: Adv Perit Dial; 1993; 9():173-6. PubMed ID: 8105917.
    Abstract:
    This report summarizes the experience with 17 pregnancies in 16 continuous ambulatory peritoneal dialysis (CAPD) patients. Early experience suggests that the outcome of pregnancy in CAPD patients may be better than in hemodialysis patients. Catheter placement can be undertaken during pregnancy with little increased risk. Peritonitis can precipitate premature labor. Blood-tinged dialysate may herald serious obstetric problems. Hypertension, anemia, and prematurity are serious problems in CAPD patients. Cesarean section can be done, with only a brief interruption in CAPD. The major modification of the usual regimen is the need for smaller exchange volumes and increased frequency. Clinicians should counsel continuous ambulatory peritoneal dialysis (CAPD) patients about contraceptive use. Hypertension contraindicates the pill. CAPD patients should not use IUDs, since they increase the risk of peritonitis. They can use barrier methods. Pregnancy is often not detected until late. The literature shows that 16 CAPD patients have had 17 pregnancies. 65% of the pregnancies resulted in surviving infants. Pregnancies of all women who conceived before starting dialysis were successful, compared to just 4 of 10 women who conceived after starting dialysis. CAPD patients have a more successful pregnancy rate than do hemodialysis patients, but the numbers are too small to be significant and selection bias may exist. Clinicians placed 11 catheters in 8 of the 16 CAPD patients between 4-29 weeks gestation. Fetal position contributed to outflow obstruction. Just 1 patient had dialysate leak. 3 peritonitis episodes occurred. Cephradine, gentamicin, cefadyl, and vancomycin were used to treat peritonitis. 2 women went into labor and delivered shortly after the onset of peritonitis. The infant delivered at 34 weeks survived, while the one delivered at 24 weeks was stillborn. Bloody dialysate was present in 3 pregnancies. It signaled abruptio placentae and subsequent fetal loss in 1 case, severe subserosal hemorrhage of the uterine wall in another case, and laceration of uterine vessels by the catheter. Hypertension complicated 9 pregnancies, but physicians managed it well and it did not cause premature delivery. 6 women had serum hemoglobin levels between 5.4 and 9 g/L. Just 2 received erythropoietin during pregnancy. Premature labor occurred in 9 pregnancies. CAPD infants are small for their gestational age. Cesarean section with no need for catheter removal was the delivery mode for 6 live born infants. Physicians had to hold dialysis for 24-72 hours after surgery. Smaller exchange volumes and increased frequency of dialysis are major changes in the usual regimen for pregnant CAPD patients.
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