pregnant diabetic dialysis patient

[karenlouise]

We have a 30 year old patient on our unit who is 6 weeks pregnant ..also an insulin dependent diabetic...historically non-compliant, one previous miscarriage...any references, stories, tips to help maintain pregnancy...is currently dialysing 6 days per week 3 hours daily. This is our first pregnancy and unknown territory for us. We are all keen to be as supportive (and realistic) as we can

[jnette, ASN, EMT-I]

Wow, Karen... I wish I had some info to offer here, but I have never had this situation before.

I would suggest asking your facility's dietician, social worker, and most certainly her nephrologist for some input on this.

Maybe between all of you putting your heads together, you can find something she'd be willing to be more compliant with.

I would hope that having a relatively healthy pregnancy and a healthy baby would be of utmost importance to her and therefore a motivating factor... but.. we know how it can be sometimes, right?

[dialysisalice]

Hi, first of all "Ouch", we had a late 20's patient who was pregnant with TWINS, newly diagnosed ESRD and Hypertensive. We were doing daily CCPD and Hemo 3 times per week on this patient to keep her creat below 3 (very ambitious). We are a small hospital based clinic in Montana and were working VERY hard to ship her to Seattle for better neonatal care and renal care. Unfortunately, pregnancy in an established dialysis patient only has about a 30% success rate, our patient had a less than 10% chance of success. Realistically, and callously, the non-compliant pregnant dialysis patient doesn't stand a chance, and if she did carry the baby to close to term (will probably not carry anywhere near term), how healthy will the baby be and how good of a mother will she be? I have suffered 5 miscarriages and they are heart breaking. My suggestion is "Hope for the best and prepare for the worst" and develop a multi-disciplinary approach that includes her OB and Pediatric docs along with the dialysis MSW, Nephrologist, dietitian and nursing. May the force be with you!