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Mary Coyle, MS, FNP

Mary Coyle, MS, FNP, is a Family Nurse Practitioner, The Renal Care Center, United Medical Associates, United Health Services Hospitals, Binghamton, NY, and is a Member of ANNA’s NYPEN Chapter.

Elyn Sulger, BSN, RN, CNN, CNA-BC, CPHQ, LNC

Elyn Sulger, BSN, RN, CNN, CNA-BC, CPHQ, LNC, is the Nurse Manager, The Renal Care Center, United Health Services Hospitals, Binghamton, NY, and is a Member of ANNA’s NYPEN Chapter.

Cindy Fletcher, MSW, LMSW

Cindy Fletcher, MSW, LMSW, is a Clinical Social Worker, The Renal Care Center, United Health Services Hospitals, and is a Field Instructor, MSW Program, Binghamton University, Binghamton, NY.

Diane Rouse, MS, RD, CDN

Diane Rouse, MS, RD, CDN, is a Clinical Dietician, The Renal Care Center, United Health Services Hospitals, Binghamton, NY.

Pregnancy in women on hemodialysis is very uncommon, and rates of spontaneous abortion, hypertension, pre-eclampsia, polyhydramnios, pre-term labor, and premature birth are high. This article documents a successful 39-week pregnancy in a woman who conceived at Stage 5 in chronic kidney disease and who started hemodialysis at 7 weeks gestation. The dialysis prescription included 3-hour treatments 5 times weekly. Blood urea nitrogen levels and fluid removal by ultrafiltration were managed according to the recommendations in the available literature. Erythropoietin and IV iron were utilized liberally for her worsening anemia. She was closely monitored by a multidisciplinary team at the dialysis center and by the perinatologist in her health care system. Pre-term labor and premature birth were avoided; however, she developed hypertension, pre-eclampsia, and polyhydramnios. She delivered a healthy female by scheduled cesarean section. There is limited data on management of this minority population, and much can be learned regarding mineral metabolism, safety and use of medications, control of hypoalbuminemia, and care practices to reduce the incidence of maternal complications and premature birth.