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Background and Aims Women with chronic kidney disease are much less likely to become pregnant and pregnany has always been considered as a challenging event both for the mother and the fetus. The challenge is harder in patients undergoing dialysis. The main objective of our work is reporting our experience of pregnancy’s cases in hemodialysis centers in southern Tunisia. Method It was a retrospective study looked at 25 spontaneous pregnancies in 19 patients treated with periodic hemodialysis in different hemodialysis centers in southern Tunisia over a period of 34 years. All pregnancies were spontaneous and are counted even spontaneous or voluntary abortions during the 1st and 2nd trimester of pregnancy Results The maternal age at the onset of pregnancy was, on average, 35.63 years ± 5.62 (between 23 and 44 years). Our study included 19 patients from southern Tunisia, 6 of them belonged to the governorate of Medenine. Hypertension was present in 7 patients (37%). The average duration of hemodialysis before conception is 4.56 years ± 3.55 (1 - 17 years). Seven patients (37%) had residual diuresis of: 1 liter per 24h in 2 cases, 500ml per 24h in other cases and the rest of the patients were anuric. All our patients were anemic before pregnancy with a mean hemoglobin level at 8 ± 1.54 g / dl (5.1 - 10.6 g / dl) with erythropoietin use in 12 (48%), folate in 11 cases (44%), intravenous iron in 11 cases (44%) and transfusion in 6 cases (24%).In our series, the average urea level was 22.19 ± 4.29 mmol / L .The urea level was lower or equal to 20 mmol / L in 8 cases (42%) and greater than 20 mmol / L in 11 cases (58%). Among the 25 pregnancies, 16 (64%) resulted in the birth of a live child: 4 intra-uterine malformations, 4 early abortions and one voluntary termination of pregnancy. There were 2 deaths within 28 days after birth. Pregnancy was considered a success if it resulted in the birth of a newborn surviving at least 28 days. Thus, the success rate was estimated at 56%. Among the maternal complications, hypertension was the most frequently complication (35% of cases). There were 2 cases of hemorrhage’s delivery as obstetrical complication. Among fetal complications, prematurity was frequent and was present in 15 cases (60%): 10 cas (40%) of average prematurity, 4 cases (16%) of great prematurity and 1 case (4%) of extreme immaturity. Hydramnios was found in 3 cases (16%). Intra-uterine growth retardation was found in 13 cases (52%) and 6 cases of death (24%) were described. Conclusion Pregnancy during chronic end stage renal failure is rare but possible. The chance of giving birth to a live child has increased in parallel with advances in hemodialysis techniques and early weight-bearing. Thus, a successful pregnancy in woman on dialysis requires collaboration among nephrologists, dialysis unit staff and obstetricians.

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