Fetomaternal outcome in sickle cell hemoglobinopathy in a tertiary care centre of North Kerala, India

Abstract

Background: Pregnancy is a serious burden to women with sickle cell disease (SCD). Our centre is the only tertiary care referral centre in the public sector which caters to the districts of Wayanad and the Nilgiris which has the maximum prevalence for SCD in South India. Hence this study was conducted to assess complications in pregnancy and maternal and perinatal outcome among women with SCD.Methods: A retrospective observational study was conducted by reviewing the medical records of all the pregnant women with SCD who had delivered in the Department of Obstetrics and Gynecology, Government Medical College, Kozhikode from January 2014 to December 2016.Results: There were 72 antenatal women with SCD during the study period with a prevalence of 0.15%. 54.17% (n = 39) patients were HbSS (sickle cell anemia), 44.44% (n = 32) were HbAS (sickle cell trait) and 1.39% (n = 1) were HbS-β thalassemia trait. There was increased risk of obstetric complications like gestational hypertension (16%), preeclampsia (11.11%), eclampsia (5.56%), HELLP syndrome (4.16%), intrauterine growth retardation (38.89%), and oligohydramnios (18.06%). Medical complications observed were mainly anaemia (76.38%), vasoocclusive crisis (18.05%), acute chest syndrome (5.56%) and infections like urinary tract infection (8.33%) and pneumonia (5.56%). The incidence of low birth weight babies (56.94%), low Apgar score (14.49%) and neonatal ICU admissions (31.88%) were high. There was no maternal mortality, but perinatal mortality was high (6.94%).Conclusion: Pregnancy in SCD is associated with an increased maternal morbidity and high perinatal mortality due to obstetric and medical complications.

Fetomaternal Outcomes among Patients with Sickle Cell Disease: A Retrospective Study

“…The majority of studies have reported similar higher rates of LBW. 3,16,17,22,26,29 Kavitha et al reported 50% cases with IUGR, which is in contrast to this study, where only 6.45% cases were reported to have IUGR. 22 Perinatal mortality documented was 9.67%, which is also lower as compared with other studies.…”

“…15 The mean age of admitted patients was 24.84 years, similar to the study done in Kerala, where the reported mean age was 25.83. 16 Anemia is the most common complication associated with SCD in this study. A total of 90.62% cases had anemia, out of which, 18.75% had severe, 53.12% had moderate, and 18.75% had mild anemia.…”

Pregnancy outcome in women with sickle cell disease/trait in a tertiary care hospital Nagpur, Maharashtra India: a descriptive cross sectional study

“…High maternal and fetal morbidity and mortality seen in pregnant mother with sickle cell disease. 1 Sickle cell trait is also potentially dangerous in the presence of certain disease states and in healthy persons under certain circumstances which lead to anoxia, dehydration or physical stress. 2 This study was undertaken to assess the pregnancy outcome in women with sickle disease and sickle cell trait at our centre who provides services to sickle cell prone ethnic groups.…”

Maternal outcome in pregnancy with sickle cell trait haemoglobinopathie

“…In a study by Couth et al, 100% moderate to severe anemia in HbSS women and only 46.8% women with AS pattern were anemic. 5 In our study, 26 (65%) had full term normal vaginal delivery, 5 women (12.5%) had preterm delivery, 35% had lower segment caesarean section. In the Kose at al study women with AS pattern (49 women), 18 (36.73%) had full term normal vaginal delivery, 8 women (16.32%) had preterm delivery, 34.69% had lower segment caesarean section.…”

“…In a study of Couth et al women with sickle cell haemoglobinopathy have been found to have higher risk for preterm delivery. 5 According to Desai et al incidence of preterm birth was as high as 44-45%. 8 These observations are similar to Sonwane et al where preterm deliveries in AS group (30.10%).…”