Pregnancy in Sickle Cell Disease in the Al Hassa Region of Saudi Arabia

Abstract

Pregnancy in sickle cell disease (SCD) patients is associated with increased risk to both mother and fetus. 1 The risk varies in different geographical areas. Very high maternal mortality rates of 11.5% have been reported from West Africa and from black American groups.2 These high mortality rates have led to suggestions by clinicians that pregnancy in SCD patients is contraindicated and have advised therapeutic abortion and sterilization. [3][4][5] In the Eastern Province of Saudi Arabia, relatively mild manifestations of SCD have been noted, as compared to the SCD on the African continent. 6 The present study was undertaken to assess the outcome of pregnancy among SCD patients in this region. Subjects and MethodsDuring the year 1997-1998, the medical records of patients admitted at the Obstetric and Gynecology Department of King Fahad Hospital, Hofuf, were retrospectively reviewed. The records of 61 SCD patients were analyzed. The criteria for SCD were based on absence of HbA 1 , HbS of more than 40%, HbA 2 of less than 3.5% and presence of HbF. These were compared with 53 sickle cell trait (SCT) patients. The criteria for SCT were based on presence of high HbA 1 , HbA 2 of less than 3.5% and HbS of less than 40%. Red cell indices in both groups showed normocytic normochromic anemia. Association of β-thalassaemia with SCD and SCT was excluded on the basis of red cell indices and HbA 2 concentration of less than 3.5%. Glucose-6-phosphate dehydrogenase (G6PD) estimation was not carried out in most of the patients, hence the association of G6PD with SCD and SCT could not be correlated. Both SCD and SCT groups were cross-matched with 84 randomly selected control patients admitted during the same period to compare the morbidity in these groups. Age, gravidity, parity, birth weight of fetus, mode of delivery, sickle cell crisis, blood transfusion and sickle cell hemoglobin percentage were recorded. Statistical analysis was done by using an Epi-Info software. Hemoglobin electrophoresis was. done on cellulose acetate in alkaline buffer, using Helena's Electrophoresis System and staining by Ponceus stain. Scanning with Clinician 2 (Helena Laboratories Densitometer) was used for quantitative evaluation of different hemoglobin bands. Hemoglobin electrophoresis which was carried out without history of blood transfusion during the previous four months was taken into consideration. ResultsIn the SCD group, the mean age was 26.3 years, mean gravidity was 4.0, and the mean parity was 3.7. The average birth weight of the fetus was 2856 g. In this group, 12 babies (19.6%) had low birth weight (less than 2500 g), 12 patients (19.6%) had fetal distress, and 31 patients (50.8%) had sickle cell crisis. There were 48 episodes of crisis (average 1.5 episodes per patient) during the pregnancies of these patients. The crises were precipitated by urinary tract infection (24 cases), respiratory tract infection (14), sore throat (6) and septicemia (4). E. coli, Kleβsiella spp. and group B Streptococcus were the most common bacteria respon...

Sickle cell disease and pregnancy in Bahrain

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Adverse maternal and perinatal outcomes in pregnant women with sickle cell disease: systematic review and meta-analysis

“…[24][25][26][27][28][29][30][31] All studies were categorized as pregnancy cohort studies. Thirteen studies originated For personal use only.…”

Appendectomy during pregnancy in sickle cell disease patients

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