Optimized Management for Successful Pregnancy Outcomes in 3 Patients on Maintenance Hemodialysis: A Case Series with Narrative Synthesis

Pregnancy success rates in women on maintenance hemodialysis (MHD) have improved, but adverse outcomes remain common. We present three cases of successful deliveries in pregnant MHD patients, supplemented by a narrative synthesis of literature to highlight key management strategies. The patients had MHD durations ranging from 2 months to 10 years. Key dialysis parameters (frequency, duration, intensity) were optimized to balance maternal hemodynamics and fetal‒placental perfusion, guided by comprehensive clinical, laboratory, and fetal monitoring. Multidisciplinary management, including strict fluid control, anemia, and thrombotic risk management, alongside tailored medication, diet, and psychological support, aimed to ensure perinatal safety. Despite efforts to prolong gestation, only one pregnancy reached full term, while the other two delivered preterm. All mothers and infants were discharged without major complications, with normal infant development and steady growth observed. Optimized MHD management during pregnancy can improve delivery outcomes and neonatal survival. This study offers a clinical reference framework for managing pregnant MHD patients.