(1) [27,28] 32 [28-31] [32-35] [36,37] [38-40] (1) (2) [41] ( indomethacin) 3-4 [1] 50% 100% 33% 36% [26,28] mg ( ) 80% 90% ( 62.5 mg 100 mg)

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1 [1-3] Gipson estrodiol [3] - [4-7] % [8] 1% 7% [9-15] [9] david620902@yahoo.com.tw 16 [16-20] [21] hcg hcg [17] (1) [22-24]21% 79% [25] [26,27]

2 (1) [27,28] 32 [28-31] [32-35] [36,37] [38-40] (1) (2) [41] ( indomethacin) 3-4 [1] 50% 100% 33% 36% [26,28] mg ( ) 80% 90% ( 62.5 mg 100 mg) [28] 80% [29]80 90 mmhg 0.5 [42] Methyldopa Hydralazine 1990 Labetolol 1. ( 52) Bagon g ( g) 62% 53% 67% Romao g ( g) 50% 36% 67% 79% Toma g ( g) 35% 44% 67% Chao g ( g) 72% 46% 46% 69% Kazancioglu g 67% 67% 67% 67% Eroglu (26-36) 1400g ( g) 29% 57% 86% Haase g 554g 40% 40% 80% 100%

3 表 2. 處理懷孕透析病人之建議 ( 修改自參考文獻 52) (iron saturation) BUN / 10-11g/dL; 50 ~ mg 0.5 HCO3 25mEq/L3-4mEq/L 45-50mg/dL 5-6(Hemodiafiltration) (night dialysis) 1.5g1.8g 30~35 Kcal 750~ 1500 ml 1500mg 2.5mEq/L 25-OH vitamin D Vitamin C B1( ) B2( ) B6 indomethacin( 5mg/dL) (non-stress test) oxytocin (ACE Inhibitors) [43-45] (ARB) [46] Labetolol 20 mg30 30hydralazine 5 10 mg BUN 50 mg/dl 20[41] Kt/V (1) (2)

4 (3) BUN 25 meq/l mg 2000 mg 2.5 meq/l 25-OH vitamin D 1,25-dihydroxyvitamin D25-OH vitamin D [47,48] 10% 20% 1.25-dihydroxy vitamin D1.25-dihydroxy vitamin D 4 6 (Hemodiafiltration) (night dialysis) [49] [50] [51] [52] Kcal 1.5g1.8 g ml1500 mg (Vitamin C B1 B2 B6) [41] 30 25% 1. Schmidt RJ, Holley JL: Fertility and contraception in endstage renal disease. Adv Ren Replace Ther 1998; 5: Faratro R, D Gama C: Pregnancy and the dialysis patient. J

5 CANNT 1999; 9: Gipson D, Katz LA, Stehman-Breen C: Principles of dialysis: Special issues in women. Semin Nephrol 1999; 19: Malik GH, al-wakeel JS, Shaikh JF, et al: Three successive pregnancies in a patient on hemodialysis. Nephrol Dial Transplant 1997; 12: Holley JL: The hypothalamic-pituitary axis in men and women with chronic kidney disease. Adv Chronic Kidney Dis 2004; 11: Hou S, Orlowski J, Pahl M, et al: Pregnancy in women with end-stage renal disease: Treatment of anemia and premature labor. Am J Kidney Dis 1993; 21: Levy DP, Giatras I, Jungers P: Pregnancy and end-stage renal disease Past experience and new insights. Nephrol Dial Transplant 1998; 13: Toma H, Tanabe K, Tokumoto T, et al: Pregnancy in women receiving renal dialysis or transplantation in Japan: A nationwide survey. Nephrol Dial Transplant 1999; 14: Hou S: Frequency and outcome of pregnancy in women on dialysis. Am J Kidney Dis 1994; 23: Bagon JA, Vernaeve H, De Muylder S, et al: Pregnancy and dialysis. Am J Kidney Dis 1998; 31: Giatras I, Levy DP, Jungers P: Pregnancy and end-stage renal disease Past and new insights. Nephrol Dial Transplant 1998; 13: Okundaye I, Abrinko P, Hou S: Registry of pregnancy in dialysis patients. Am J Kidney Dis 1998; 31: Reister F, Reister B, Heyl W, et al: Dialysis and pregnancy A case report and review of the literature. Ren Fail 1999; 21: Holley J, Reddy S: Pregnancy in dialysis patients: A review of outcomes, complications, and management. Semin Dial 2003; 16: Eroglu D, Lembet A, Ozdemir F, et al: Pregnancy during hemodialysis: Perinatal outcome in our cases. Transplant Proc 2004; 36: Jones DC: Pregnancy complicated by chronic renal disease. Clin Perinatol 1997; 24: Hou S, Firanek C: Management of the pregnant dialysis patient. Adv Ren Replace Ther 1998; 5: MacCarthy EP, Pollak VE: Maternal renal disease: Effect on the fetus. Clin Perinatol 1981; 8: Davison JM: Dialysis, transplantation, and pregnancy. Am J Kidney Dis 1991; 17: Walsh A: Management of a pregnant woman dependent on hemodialysis. EDTNA ERCA J 2002; 28: Piccoli G, Bontempo S, Mezza E, et al: Sudden development of low tolerance of dialysis in a young female patient. Nephrol Dial Transplant 2004; 19: Kazanicioglu R, Sahin S, Turknen A, et al: The outcome of pregnancy among patients receiving hemodialysis treatment. Clin Nephrol 2003; 59: Chao AS, Huang JY, Lien R, et al: Pregnancy in women who undergo long term hemodialysis. Am J Obstet Gynecol 2002; 187: Romao JE, Luders C, Kahrale S, et al: Pregnancy in women on chronic dialysis: A single center experience of 17 cases. Nephron 1998; 78: Hou S: Pregnancy in dialysis patients: Where do we go from here? Semin Dial 2003; 16: Keller F, Griesshammer M, Haussler U, et al: Pregnancy and renal failure: The case for application of dosage guidelines. Drugs 2001; 61: Haase M, Morer S, Bamberg C, et al: A systematic approach to managing pregnant dialysis patients The importance of an intensified haemodiafiltration protocol. Nephrol Dial Transplant 2005; 20: Hou S: Pregnancy in chronic renal insufficiency and endstage renal disease. Am J Kidney Dis 1999; 33: Hussey M, Pombar X: Obstetric care for renal allograft recipients of for women treated with hemodialysis or peritoneal dialysis during pregnancy. Adv Ren Replace Ther 1998; 5: Hou S: Conception and pregnancy in peritoneal dialysis patient. Perit Dial Int 2001; 21: S Yasin SY, Bey Doun SN: Hemodialysis in pregnancy. Obstet Gynecol Surv 1988; 43: Millar LK, DeBuque L, Wing DA: Uterine contraction frequency during treatment of pyelonephritis in pregnancy and subsequent risk of preterm birth. J Perinat Med 2003; 31: Andrews WW, Goldenberg RL, Mercer B, et al: The preterm prediction study: Association of second trimester genitourinary Chlamydia infections with subsequent spontaneous preterm birth. Am J Obstet Gynecol 2000; 18: Lopez NJ, Smith PC, Gutierrez J: Periodontal therapy may reduce the risk of preterm low birth weight in women with periodontal disease: A randomized controlled trial. J Periodontol 2002; 73: Cnattingius S, Forman MR, Berendes HW, et al: Effect of age, parity, and smoking on pregnancy outcome: A population-based study. Am J Obstet Gynecol 1993; 168: Sanchez-Ramos L, Kaunitz AM, Delke I: Progestational agents to prevent preterm birth: A metaanalysis of randomized controlled trials. Obstet Gynecol 2005; 105: Dodd JM, Crowther CA, Cincotta R, et al: Progesterone supplementation for preventing preterm birth: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2005; 84: Meis PJ, Klebanoff M, Thom E, et al: Preventions of recurrent preterm delivery by 17 alphahydroxyprogesterone caproate. N Engl J Med 2003; 348: Da Fonseca EB, Bittar RE, Cavalho MH, et al: Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: A randomized placebo-controlled doubleblind study. Am J Obstet Gynecol 2003; 188: ACOG Committee Opinion Use of progesterone to reduce preterm birth. Obstet Gynecol 2003; 102: Shemin D: Dialysis in pregnant women with chronic kidney disease, Semin Dial 16 (2003), pp Jungers P, Chauveau D: Pregnancy and renal disease. Kidney Int 1997; 52: Pryde PG, Sedman AB, Nugent CE, et al: Angiotensin-converting enzyme inhibitor fetopathy. J Am Soc Nephrol 1993; 3: Bhatt-Mehta V, Deluga KS: Fetal exposure to lisinopril: Neonatal manifestations and management. Pharmacotherapy 1993; 13: Cooper WO, Hernandez-Diaz S, Abrogast PG, et al: Major congenital malformations after first-trimester exposure to ACE inhibitors. N Engl J Med 2006; 354: Hu F, Morrissey P, Yao J, et al: Development of AT (1) and AT (2) receptors in the ovine fetal brain. Brain Res Dev Brain Res 2004; 150: Hussain S, Savin V, Piering W, et al: Phosphorus-enriched hemodialysis during pregnancy: Two case reports. Hemodial Int 2005; 9:

6 48. Chan W, Okun N, Kjellstrand C: Pregnancy in chronic dialysis: A review and analysis of the literature. Int J Artif Organs 1998; 21: Gangji A, Windrim R, Gandhi S: Successful pregnancy with nocturnal hemodialysis. Am J Kidney Dis 2004; 44: Hou S: Pregnancy in women treated with peritoneal dialysis: Viewpoint Perit Dial Int 1996; 16: Chang H. Miller MA, Bruns FJ: Tidal peritoneal dialysis during pregnancy improves clearance and abdominal symptoms. Perit Dial Int 2002; 22: Reddy SS, Holley JL: Management of the pregnant chronic dialysis patient. Adv Chronic Kidney Dis 2007; 14(2):

戴珊如 BUN Cr GFR Na mmol/l K mmol/l P mg/l Ca Hb Ht % UA Alb g/dl TC TG 28 8 30 102 7.5 6.7 138 4.7 8 6 16.7 28 9 1 83 7.2 7 4.2 6.9 7.2 13 3.9 368 33

戴珊如 BUN Cr GFR Na mmol/l K mmol/l P mg/l Ca Hb Ht % UA Alb g/dl TC TG 28 8 30 102 7.5 6.7 138 4.7 8 6 16.7 28 9 1 83 7.2 7 4.2 6.9 7.2 13 3.9 368 33 個案報告血液透析孕婦之營養照護經驗摘要慢性腎臟病 chronic kidney disease, CKD 患者懷孕是罕見的病例增加每週的透析時間且整合多科治療可提高懷孕成功的機會一位 32 歲 CKD 女性於懷孕 28 週時住院並開始接受每週 4 次的