Objective: To compare pregnancy outcomes based on mode of delivery in
women with homozygous sickle cell disease (HbSS) to women without
(HbAA). Design and setting: Retrospective observational study was
performed using delivery records of 48,600 parturients between January
1992 and January 2020 at a Jamaican hospital. Methods: We identified 250
women with HbSS and 252 age-matched with AA phenotype. Stratification
based on mode of delivery revealed: 150 vaginal and 105 caesarean
deliveries (HbSS), 185 vaginal and 67 caesarean deliveries (HbAA).
Fisher’s exact tests and Mann-Whitney test were used to analyze
variables based on sickle cell status. Unadjusted and adjusted odds
ratios were calculated based on mode of delivery. Main outcome measures:
Maternal and perinatal morbidity in women with HbSS and HbAA genotypes
exposed to vaginal or caesarean section delivery. Results: Vaginal
delivery and HbSS were more associated with labour
induction/augmentation (AOR= 2.4, (0.7–7.8)), intrapartum complications
(AOR= 2.6, (0.5–14), postpartum hemorrhage (AOR= 2.8 (0.5–15.2)), and
postpartum infections (AOR= 9.6 (1.7–54.4)). Caesarean delivery
resulted in more postpartum infections in the HbSS group (AOR = 23.6
(0.9 – 638.4)). There were no differences in rates of neonatal deaths
(n (%); 3 (4) vs. 0(0), p=0.250); or stillbirths between the groups.
Conclusion: Vaginal delivery in HbSS resulted in more intrapartum
complications, postpartum hemorrhage, hypertensive disorders, and
postpartum infections. Cesarean delivery in HbSS increases the risk of
postpartum infections and hypertensive disorders. There was no increased
risk of adverse perinatal outcomes regardless of mode of delivery.