Management of Pregnancy in Sickle Cell Anemia

Abstract

There has been significant decrease in maternal morbidity and mortality of sickle cell disease patients during pregnancy due to better understanding of the pathophysiology of the disease and physiologic changes during pregnancy.Prophylactic blood transfusion does not appear to reduce complications in patients with sickle cell anemia. Patients with sickle hemoglobin C disease and with Sp thalassemia' have fewer complications but still need close monitoring.Blood transfusion therapy should be made available for medical and obstetrical complications to include increasing hypoxemia, progressive anemia, acut chest syndrome, twin pregnancy, splenic sequestration syndrome, preeclampsia, septicemia, or prior to general anesthesia and surgery. Blood transfusion therapy is associated with hepatitis, allergic reaction, alloimmunization, AIDS, and iron overload states. These aspects should be considered prior to using blood transfusion therapy.Excellent prenatal monitoring and aggressive intervention should be instituted when problems arise for the successful management of the pregnant patient with sickle cell disease. Prenatal diagnosis and cord blood screening should be made available for the infant. Appropriate pediatric referral and prophylactic penicillin is recommended for the infant with sickle cell disease.

Prophylactic transfusion for pregnant women with sickle cell disease: a systematic review and meta-analysis

“…19,28 Seven studies specified outcomes based on b-globin genotype. 10,15,18,19,26,28,30 Confounding variables were generally not addressed in the study design or analysis.…”

“…Protocols varied across reports and the type of transfusion depended on the degree of anemia in 5 studies. 10,15,16,19,30 Timing of prophylactic transfusion differed, with only 2 studies instituting the intervention in early to midpregnancy. 10,15 The proportion of patients receiving prophylactic transfusion and needing additional on-demand transfusions was not reported in the majority of studies and varied widely in the studies in which it was reported (5.6-60.7%).…”

“…10,15,16,19,30 Timing of prophylactic transfusion differed, with only 2 studies instituting the intervention in early to midpregnancy. 10,15 The proportion of patients receiving prophylactic transfusion and needing additional on-demand transfusions was not reported in the majority of studies and varied widely in the studies in which it was reported (5.6-60.7%). 14 In the single RCT conducted by Koshy et al, 16 the prophylactic transfusion group received simple or partial exchange transfusions to achieve the following targets: hemoglobin of 100 to 110 g/L, Hct of 33%, and HbS ,35%.…”

“…13 Furthermore, reports assessing the effect of prophylactic RBC transfusions on pregnancy outcomes in SCD have been inconsistent. [14][15][16][17][18][19] Thus, the objective of this study was to systematically review the impact of prophylactic transfusion compared with on-demand transfusion (defined as transfusion instituted to treat complications) on maternal and neonatal adverse pregnancy outcomes in pregnant women with SCD.…”

Effect of Sickle Cell Anemia on Pelvic Dimensions: A Magnetic Resonance Imaging Study

“…Affected women are associated with high rates of prenatal and natal complications, and cesarean birth rates tend to be higher in women with SCA (2)(3)(4)(5)(6). Because fetomaternal morbidity and mortality increases with prolonged labor, choosing the right type of delivery is important.…”