Cotton (Umbilical) Tape as Suture Material for Cervical Cerclage: A Case Series

2010 ◽  
Vol 2 (2) ◽  
pp. 127-128
Author(s):  
Randhir Puri ◽  
MB Bellad ◽  
JC Shravage
Keyword(s):  
Gestational Age ◽  
Suture Material ◽  
Multiple Pregnancy ◽  
Case Series ◽  
Posterior Surface ◽  
Singleton Pregnancy ◽  
Cervical Cerclage ◽  
Fetal Survival ◽  
Term Delivery ◽  
Gestational Age At Delivery

ABSTRACT Introduction The present case series was an attempt to find out cotton (umbilical) tape usefulness as suture material for cervical encerclage as it is presterilized, easily visible and economical. Methods Objective To determine utility of cotton tape as suture material for cervical cerclage. Study design: A case series. Place KLES Hospital and District Hospital, Belgaum. Period 1997 to 2001. Inclusion criteria Singleton pregnancy, gestational age by USG (14-26 weeks), H/o 2nd trimester abortions, H/o Pre-term labor, elective cerclage. Exclusion criteria Medical diseases, multiple pregnancy, emergency encerclage, fetal anomalies by USG, not willing to provide consent. Outcome Gestational age at delivery, fetal survival, morbidity [white discharge per vagina (PV), cervical dystocia, puerperal pyrexia]. Intervention Cerclage with cotton tape. Technique Modified Mc Donald's: The suture is commenced from the posterior surface of the cervix and knot is put in the posterior surface. Results 89.3% (25 women) had term deliveries, i.e. 37 to 40 weeks, 7.1% (2 women) had spontaneous delivery at 36 weeks and one women (3.6%) had pre-term delivery at 30 weeks with the fetal survival was 96.4%. Conclusion The present case series proves that the simple economical cotton (umbilical) tape is effective as a suture material for cervical encerclage. However a larger randomized trial can confirm these findings.

scholarly journals Effects and outcomes of septostomy in twin-to-twin transfusion syndrome after fetoscopic laser therapy

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Wen-Fang Li ◽  
An-Shine Chao ◽  
Shuenn-Dyh Chang ◽  
Po-Jen Cheng ◽  
Lan-Yan Yang ◽  
...  
Keyword(s):  
Laser Therapy ◽  
Gestational Age ◽  
Odds Ratio ◽  
Case Series ◽  
Perinatal Outcomes ◽  
Neonatal Brain ◽  
Brain Image ◽  
Fetal Survival ◽  
Gestational Age At Delivery ◽  
Adverse Perinatal Outcomes

Abstract Background To evaluate the incidence and outcomes of septostomy in twin-to-twin transfusion syndrome (TTTS) after fetoscopic laser therapy. Methods A retrospective analysis of TTTS postlaser septostomy between 2005 and 2018 was performed. Postlaser septostomy was diagnosed using both (1) a free-floating intertwin membrane flap visible on ultrasound examination and (2) the rapid equalization of amniotic fluid maximum vertical pocket in the donor and recipient amniotic sacs observed after laser therapy. Perinatal survival, neonatal brain image anomaly, gestational age at operation and birth, incidence of premature rupture of membranes (PROM) within 3 weeks after operation, pseudoamniotic band syndrome, and cord entanglement were evaluated. Results In the 159 TTTS cases included, 12 had postlaser septostomy. Relative to the group without septostomy, the septostomy group had a lower total fetal survival rate (54.2% vs 73.6%, p = 0.041), an earlier mean gestational age at delivery (27.8 vs 34.4 weeks, p = 0.009), a higher risk of PROMs within 3 weeks after operation (33.3% vs 5.4%, p = 0.004), a higher cord entanglement rate (16.7% vs 0%, p = 0.005), and a higher brain image anomaly rate (23.0% [3/13] vs 5.0% [11/218], p = 0.035). After considering the severe Quintero stages (stage III and IV), postlaser septostomy was the only variable [p = 0.003, odds ratio = 5.1] to predict neonatal brain image anomaly. Postlaser septostomy combined with severe Quintero stages could predict PROMs within 3 weeks after laser therapy [p = 0.001, odds ratio = 14.1 and p = 0.03, odds ratio = 5.4, respectively] and delivery before the gestational age of 28 weeks [p = 0.017, odds ratio = 4.5 and p = 0.034, odds ratio = 2.3, respectively]. The risk of pseudoamniotic band syndrome was not increased by postlaser septostomy in this case series. Conclusions Postlaser septostomy in TTTS was associated with poorer fetal survival and more adverse perinatal outcomes even after considering severe Quintero stages before laser therapy. Efforts should be made to prevent septostomy during laser therapy, and septostomy as the primary method to treat TTTS is not advisable.

scholarly journals CERVICAL CERCLAGE;

2019 ◽  
Vol 26 (05) ◽  
Author(s):  
Uzma Manzoor ◽  
Uzma Shahzad ◽  
Nadia Sharif ◽  
Sadia Bano ◽  
Raheela Farhat ◽  
...  
Keyword(s):  
Gestational Age ◽  
Normal Pregnancy ◽  
Fetal Outcome ◽  
Clinical Findings ◽  
Cervical Cerclage ◽  
Trimester Abortion ◽  
Live Births ◽  
Fetal Survival ◽  
Cervical Incompetence ◽  
Gestational Age At Delivery

Introduction: In Pakistan, cervical incompetence has been recognized as the leading cause of recurrent abortions in mid trimester. The elective cerclage based on history and clinical findings applied in second trimester overcomes the risk of emergency procedure. This problem is quite common in patients visiting IUH Faisalabad. Objectives: Assess gestational age at delivery after elective cervical cerclage application in mothers with recurrent mid trimester abortions. List the immediate and late complications of cerclage. Assess the fetal outcome after cerclage. Outcome Measures: 1. Percentage of mid trimester abortion in current pregnancy. 2. Frequency of prolongation of gestational age at delivery. 3. Complications of the procedure. 4. Birth weight of the baby. 5. Percentage of live births. 6. Fetal survival rate. Study Design: Interventional: Quasi experimental study. Setting: Department of Obstetrics and Gynaecology, Teaching Hospital IUH FSD. Period: Oct 2016 to July 2018. Subjects: Fifty patients with recurrent mid trimester miscarriage due to cervical incompetence. Methods: Patients were admitted through outdoor with history of previous mid trimester abortions possibly due to cervical incompetence. USG evidence of normal pregnancy with no obvious congenital anomaly was a pre requisite for cervical cercalge. Technique used was MCDonald’s suture under general anaesthesia. Results: Effectiveness of cerclage was 90%; 78% had term deliveries, 12% preterm delivery and 5 spontaneous mid trimester abortions. There were 81% live births. The complications included cervical trauma after delivery (2%), spontaneous abortions (10%), pre term delivery (13%) and pre prom (2%). Conclusion: Elective cerclage at 12-14 wks of gestation in recurrent mid trimester abortions results in good fetomaternal outcome with almost no complications.

scholarly journals Efficacy of an Emergency Cervical Cerclage Using Absorbable Monofilament Sutures

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Yuka Sato ◽  
Nobuhiro Hidaka ◽  
Takahiro Nakano ◽  
Saki Kido ◽  
Masahiro Hachisuga ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Spontaneous Abortion ◽  
Gestational Age ◽  
Perinatal Outcomes ◽  
Cervical Length ◽  
Cervical Cerclage ◽  
Extremely Preterm ◽  
Term Delivery ◽  
Gestational Age At Delivery ◽  
Full Term Delivery

Introduction. Although nonabsorbable woven tape has been widely used for cervical cerclage, technical difficulties that can occur with an effaced cervix because of the thickness of the tape, and the risks of local infection are two major concerns. This study investigated perinatal outcomes of pregnancies involving an emergency cervical cerclage using absorbable monofilament polydioxanone sutures, which is a narrow thread and protects against bacterial infection. Materials and Methods. We performed a chart review of patients who underwent emergency McDonald cerclage with polydioxanone sutures at our institution between 2007 and 2015. Gestational age at delivery, duration between cerclage and delivery, and neonatal prognosis were evaluated as primary outcomes. Results. Among the 23 patients (18 singleton and five twin pregnancies) evaluated, ultrasound-indicated (progressive cervical length shortening) were eight (35%) and physical examination-indicated (fetal membranes that prolapsed into the vagina or dilated cervix) were 15 patients (65%). The median gestational age at cerclage was 22+3 weeks (range, 17+5 to 25+3 weeks). Postoperative spontaneous abortion occurred in only one patient. The median gestational age at delivery was 32+5 weeks (range, 20+5 to 40+6 weeks). Extremely preterm delivery before 28 weeks of gestation occurred in four (17%) cases. Full-term delivery was achieved in 10 (42%) cases. The duration between cerclage and delivery ranged from 5 to 136 days (median, 77 days). Except for one case of spontaneous abortion, all newborns survived till hospital discharge. Conclusions. Although our series included some patients at high risk for spontaneous abortion and preterm delivery, satisfactory prolongation and favorable neonatal outcomes were achieved for most patients by using absorbable monofilament sutures, thus suggesting the efficacy of this type of suture for emergency cervical cerclage.

MO254PREGNANCY OUTCOMES AND COMPLICATIONS IN PATIENTS WITH CHRONIC GLOMERULONEPHRITIS*

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Elena Prokopenko ◽  
Aleksei Zulkarnaev ◽  
Irina Nikol`skaya ◽  
Andrey Vatazin ◽  
Daria Penzeva
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Preterm Delivery ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Multiple Pregnancy ◽  
Chronic Glomerulonephritis ◽  
Gestational Age At Delivery ◽  
Negative Effect ◽  
Adverse Pregnancy

Abstract Background and Aims Pregnancy in patients with chronic glomerulonephritis (CGN) is associated with higher risk of complications and unfavorable outcomes compared to the general population. The aim of the study was to determine the incidence of pregnancy complications and outcomes in patients with preexisting CGN. Method 126 pregnancies in 119 women with CGN and CKD 1-4 stages: 1 st. – 86 patients, 2 st. – 17, 3 st. – 20, 4 st. – 3 and 20 pregnancies in 20 age-matching healthy women were included. Patients with secondary CGN, multiple pregnancy, pregnancy after IVF were excluded. A kidney biopsy was performed in 18 of 119 (15.1%) women: 15 – before conception and 3 – after delivery. IgA-nephropathy was detected in 11 of 18 (61.1%) patients, MCD/FSGS – in 4 (22.2%), MPGN – in 3 (16.7%). The incidence of unfavorable pregnancy outcome, preeclampsia (PE), preterm delivery, cesarean section (CS), low birth weight (LBW < 2500 g), small for gestational age (SGA) newborn (birth weight < 10th percentile), mean term of delivery, mean birth weight, frequency of treatment in neonatal intensive care unit (NICU) and achieving of end-stage kidney disease in mothers after delivery were evaluated. Results CKD was first diagnosed during pregnancy in 34.1% women with CGN. The incidence of adverse pregnancy outcomes, preterm delivery, LBW, SGA, and treatment in the NICU did not differ between groups, while the frequency of PE and CS were higher, and mean gestational age at delivery, birth weight were lower in the CGN group compared to the healthy control (Table). Severe PE was observed in 6 of 32 (18.7%) patients with PE and CGN. The incidence of PE increased in advanced stages of CKD, but the differences were not significant: 19.8% - in CKD1, 35.3% - CKD2, 35% - CKD3, 66.7% - CKD4, p=0.112. The frequency of PE depended on the presence of baseline nephrotic-range proteinuria (NPU) and chronic arterial hypertension (AH): PE was observed in women w/o NPU and w/o AH in 8.3% cases, w/o NPU and with AH – in 39%, with NPU and w/o AH – in 44,4%, with NPU and with AH – in 43.8%, p=0.00048. Preterm delivery, CS and LBW were more common in women with chronic renal failure, and their frequency increased with increasing severity of CKD: CKD1 – 3.5%, 21.2%, 3.5% resp.; CKD2 – 6.7%, 53.3%, 20%; CKD3 – 40%, 70%, 40%; CKD4 – 100%, 100%, 100% (p<0.0001, for all characteristics). We found differences in gestational age at delivery depending on the stages of CKD: in CKD1 it was 38.9 ± 1.3 wks, CKD2 – 38.2 ± 2.1 wks, CKD3 – 36.3 ± 3.5 wks, CKD4 – 32.4 wks (one child), p=0.00013. The proportion of newborns requiring intensive care was higher in mothers with CKD3 (30%) and CKD4 (100%) compared with CKD1 (0%) and CKD2 (13.3%), p<0.0001. Five of 126 (4%) patients in CGN group achieved stage 5 CKD with average postpartum follow-up period of 92.6 ± 20.5 months; 4 women had CKD3 during pregnancy, one – CKD1. Now 2 patients are treated with regular hemodialysis, 3 - live with kidney transplant. Conclusion Chronic glomerulonephritis has a negative effect on pregnancy course, increasing the incidence of PE and CS and contributing to reduce gestational age and birth weight. Incidence of preterm delivery, CS, LBW and proportion of newborns treated in NICU were highest in patients with CKD 3-4.

Local incidence of Jarisch–Herxheimer reaction in pregnancy following penicillin treatment for syphilis: A case series

2021 ◽  
pp. e20210001
Author(s):  
Amreet Dhaliwal ◽  
Alison A Lopez ◽  
Jared Bullard ◽  
Vanessa Poliquin
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Gestational Age ◽  
Tertiary Care ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Antimicrobial Treatment ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Gestational Age At Delivery

Background: The literature suggests that the Jarisch–Herxheimer (J-H) reaction following antimicrobial treatment of syphilis is common and may precipitate uterine activity. Local practice is to transfer syphilitic parturients beyond gestational age of viability from rural locations to a tertiary care centre for treatment. Study objectives were to delineate local incidence and risk factors for the J-H reaction among pregnant women receiving treatment for syphilis. Methods: A retrospective chart review was conducted on pregnant women diagnosed with syphilis and treated during pregnancy at a tertiary care centre between 2012 and 2018. J-H reaction was defined as having ≥1 of the following symptoms within 24 hours of antibiotic treatment: fever (temperature ≥38°C), clinical description of a painful or itchy skin lesion, headache, hypotension (systolic BP <90), uterine contractions, or fetal heart rate decelerations. Descriptive statistical analysis was performed with mean and median used as measures of central tendency for continuous and categorical data, respectively. Results: Fifty-eight charts were eligible for inclusion. Mean maternal age was 25.1 (SD 5.6) years, and mean gestational age was 20.4 (SD 9.5) weeks when syphilis was diagnosed. One patient (1/58, 1.7%) met J-H reaction criteria. Mean gestational age at delivery was 37.1 (SD 3.4) weeks. One stillbirth (1.7%) was identified. Conclusions: The J-H reaction is less common at our centre than the literature suggests. Further research is important to identify risk factors associated with J-H reaction to optimize resource allocation in the context of treatment of syphilis during pregnancy.

scholarly journals Emergency cerclage: gestational and neonatal outcomes

2019 ◽  
Vol 65 (5) ◽  
pp. 598-602 ◽  
Author(s):  
Maíra Marinho Freire Costa ◽  
Antonio Gomes de Amorim Filho ◽  
Mônica Fairbanks de Barros ◽  
Agatha Sacramento Rodrigues ◽  
Marcelo Zugaib ◽  
...  
Keyword(s):  
Gestational Age ◽  
Death Rate ◽  
Fetal Death ◽  
Expectant Management ◽  
Neonatal Outcomes ◽  
Cervical Dilatation ◽  
Singleton Pregnancy ◽  
Fetal Death Rate ◽  
Significant Difference ◽  
Gestational Age At Delivery

SUMMARY BACKGROUND: The gestational and neonatal outcomes of women with early cervical dilatation undergoing emergency cerclage were evaluated and compared with women treated with expectant management and bed rest. METHODS: Retrospective analysis of pregnant women admitted between 2001 and 2017 with a diagnosis of early cervical dilatation and/or bulging membranes. Patients with a singleton pregnancy of a fetus without malformations, between 16 and 25 weeks and 6 days, with cervical dilatation of 1 to 3 cm were included; patients who delivered or miscarried within 2 days after admission were excluded. RESULTS: The study enrolled 30 patients: 19 in the cerclage group and 11 in the rest group. There was a significant difference, with the cerclage group showing better results concerning gestational age at delivery (28.7 vs. 23.3 weeks; p=0.031) and latency between hospital admission and delivery (48.6 vs. 16 days; p=0.016). The fetal death rate was lower in the cerclage group (5.3% vs. 54.5%, p=0.004). Considering gestational age at delivery of live newborns, no difference was observed between the cerclage and rest groups (29.13 vs. 27.4 weeks; p=0.857). CONCLUSIONS: Emergency cerclage was associated with longer latency, a significant impact on gestational age at delivery and reduction in the fetal death rate.

Emergency Cerclage: Improvement of Outcomes by Standardization of Management

2015 ◽  
Vol 39 (2) ◽  
pp. 134-139 ◽  
Author(s):  
Mariona Rius ◽  
Teresa Cobo ◽  
Raúl García-Posadas ◽  
Sandra Hernández ◽  
Irene Teixidó ◽  
...  
Keyword(s):  
Gestational Age ◽  
Perinatal Outcomes ◽  
Postoperative Management ◽  
Standard Protocol ◽  
Delivery Time ◽  
Cervical Cerclage ◽  
Maternal Characteristics ◽  
Tertiary Referral Center ◽  
Gestational Age At Delivery ◽  
Selection Of

Introduction: Cervical dilatation followed by prolapse and ballooning of membranes into the vagina at mid-gestation is a critical situation. The aim of this study was to describe the outcome of emergency cerclage in a tertiary referral center during a 10-year period (2001-2010) in which a defined selection of women and standard protocol were introduced. Subjects and Methods: Thirty-nine cases of emergency cervical cerclage performed before 24 completed weeks were retrospectively reviewed. Data related to maternal history, diagnosis, procedure details, postoperative management and perinatal outcome were recorded. Maternal characteristics and perinatal outcomes are described. Results: Gestational age at cerclage (mean ± SD) was 22.1 ± 2.0 weeks with 61% (24/39) of women presenting bulging membranes. Gestational age at delivery and cerclage-to-delivery time (mean ± SD) were 28.6 ± 6.2 weeks and 49.1 ± 36.5 days, respectively. Only 38.5% (15/39) of the whole group and 44.1% (15/34) of those who reached 24.0 weeks delivered beyond 28 weeks of gestational age. Neonatal survival before discharge was 82.4% (28/34). Discussion: Perinatal outcomes after emergency cerclage are still poor with more than half of the cases delivering before 28 weeks. A standard protocol may help in the management of these rare cases.

scholarly journals Outcome of Multifetal Pregnancy Reduction in Women with a Dichorionic Triamniotic Triplet Pregnancy to a Singleton Pregnancy: A Retrospective Nationwide Cohort Study

2015 ◽  
Vol 40 (2) ◽  
pp. 94-99 ◽  
Author(s):  
L. van de Mheen ◽  
S.M.P. Everwijn ◽  
M.C. Haak ◽  
G.T.R. Manten ◽  
H.A. Zondervan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Gestational Age ◽  
Survival Rates ◽  
Triplet Pregnancy ◽  
Singleton Pregnancy ◽  
Gestational Age At Delivery ◽  
Gestational Age At Birth ◽  
Multifetal Pregnancy ◽  
Perinatal Survival ◽  
Multifetal Pregnancy Reduction

Objective: To study the pregnancy outcomes of women with a dichorionic triamniotic triplet pregnancy that was reduced to a singleton pregnancy and to review the literature. Methods: We performed a nationwide retrospective cohort study. We compared time to delivery and perinatal mortality in dichorionic triplet pregnancies reduced to singletons with ongoing dichorionic triplet pregnancies and primary singleton pregnancies. Additionally, we reviewed the literature on the subject. Results: We studied 46 women with a reduced dichorionic triplet pregnancy and 42 women with an ongoing dichorionic triplet pregnancy. Median gestational age at delivery was 38.7 vs. 32.8 weeks, respectively (p < 0.001). Delivery <24 weeks occurred in 9 (19.6%) women with a reduced triplet pregnancy and 4 (9.5%) with an ongoing triplet pregnancy (p = 0.19). Perinatal survival rates between the reduced group and the ongoing triplet group were not significantly different. Conclusion: Multifetal pregnancy reduction in women with a dichorionic triplet pregnancy to a singleton pregnancy prolongs median gestational age at birth. No statistically significant association was found with miscarriage and perinatal survival rates.

Routine Cervical Cerclage in Higher Order Multiple Gestation — Does It Prolong the Pregnancy?

Twin Research ◽  
2002 ◽  
Vol 5 (2) ◽  
pp. 67-70 ◽  
Author(s):  
Alexander Strauss ◽  
Ivo M. Heer ◽  
Udo Janßen ◽  
Christian Dannecker ◽  
Peter Hillemanns ◽  
...  
Keyword(s):  
Gestational Age ◽  
Perinatal Outcome ◽  
Positive Impact ◽  
Multiple Pregnancy ◽  
Medical Intervention ◽  
Multiple Gestation ◽  
Perinatal Morbidity ◽  
Cervical Cerclage ◽  
Significant Difference ◽  
Prophylactic Cerclage

AbstractPreterm birth following cervical dilatation is the greatest threat to infants of a multiple pregnancy. Lacking reliable data concerning the effect of prophylactic cerclage, we compared a study group to controls for maternal and perinatal outcome. Sixteen of 94 triplet-, 9 of 18 quadruplet/quintuplet-pregnancies, treated with prophylactic cerclage, were retrospectively compared to those without cervical cerclage respectively. Kruskal-Wallis test and Mann-Whitney-U test were performed as non-parametric one way analysis of variance. For the analysis of frequencies Chi Square test or Fisher’s exact test were performed. Odds ratio with 95% confidence interval was used to compare the need for intravenous tocolysis as well as perinatal morbidity and mortality. Gestational age at delivery was not different from the controls in all studied groups. Birth weight revealed a 200g dominance for the “no cerclage-triplets”, while this significant difference was inverted for quadruplets/quintuplets (1245g vs. 1069g). With respect to gestational age at birth, need for hospitalisation or medical intervention no benefit was achieved. Moreover, perinatal outcome analysed by arterial pH, APGAR-Score and perinatal mortality was not altered by a prophylactic cerclage. Perinatal morbidity for quadruplets and quintuplets was even higher in cerclage pregnancies. Therefore, these retrospective results disclaim a positive impact of cervical cerclage on pregnancy management or perinatal outcome in multifetal pregnancies.

Pregnancy in Chronic Dialysis: A Review and Analysis of the Literature

1998 ◽  
Vol 21 (5) ◽  
pp. 259-268 ◽  
Author(s):  
W.S. Chan ◽  
N. Okun ◽  
C.M. Kjellstrand
Keyword(s):  
Renal Failure ◽  
Peritoneal Dialysis ◽  
Gestational Age ◽  
English Literature ◽  
Age At Onset ◽  
Creatinine Ratio ◽  
Fetal Survival ◽  
Gestational Age At Delivery ◽  
The Mean ◽  
Dialysis Complications

Pregnancy is uncommon in end-stage renal failure, particularly in patients requiring dialysis. We reviewed the literature from 1965 to date, seeking an optimal way of dialyzing pregnant women after encountering one such patient. Methods We searched the English literature by cross-referencing “pregnancy” with “hemo-” or “peritoneal dialysis” and “renal failure”. Eighty-six pregnancies worldwide were found to which we added one case of our own. Various independent factors were studied against gestational age at delivery using uni- and multivariate analysis. These factors included mother's age, previous delivery, diagnoses of renal disease, dialysis duration prior to pregnancy, gestational age at onset of dialysis, dialysis type, level of hemoglobin during pregnancy, BUN and creatinine targets, BUN/creatinine ratio, dialysis intensity at the beginning and end of pregnancy, influence of erythropoietin and dialysis complications. Results Of the 87 pregnancies, 12% resulted in stillbirths, 9% of neonates died prior to discharge. The mean gestational age at delivery was 32 ± 5 weeks, and the mean birth weight 1604 ± 652 g. Two congenital abnormalities and one twin pregnancy were reported. 48% of deliveries were premature. Pre-eclampsia was reported in 11%, and worsening hypertension in 17%. CAPD was used in 25 and hemodialysis in 62 patients. Fetal survival was similar in both cases (72% vs 82%), although incidence of various dialysis complications differed. The conventional dialysis goals of a low target BUN level and hemoglobin for pregnant patients were not factors in predicting fetal outcome. The number of hemodialyses/week were negatively correlated (R = -0.35, P = 0.061), but the hours of dialysis positively correlated (R = 0.42, p = 0.035) to gestational age. Fetal survival was independently influenced by creatinine level [564 µmol/L when baby survived vs 788 µmol/L when baby died (p = 0.021)], BUN/creatinine ratio (50 vs 30, p = 0.053), and hours of dialysis (5.6 hrs vs 3.6 hrs, p=0.013). There was no relation of either frequency or volume of peritoneal dialysis exchanges to gestational age or fetal survival. Conclusions Greater attention to a high intake of protein (>1.5 g/kg) and higher dose of hemodialysis, achieved by longer, every other day dialysis, may be the optimal approach to pregnant patients on hemodialysis. Our first attempt to define the goal of hemodialysis is to keep the predialysis creatinine below 600 mmol/L and the protein intake high enough so the predialysis BUN level is >25 mmol/L. There are no clear guidelines on how to best perform CAPD.

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