Sickle cell crisis and pregnancy

Parrish, Marc; Morrison, John C.

doi:10.1053/j.semperi.2013.04.006

Cited by 29 publications

(19 citation statements)

References 34 publications

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“…Given the lack of formal evidence to guide clinical practice, we believe that pregnant women with SCD should be managed by a multidisciplinary team including haematologists and obstetricians with experience in high‐risk pregnancy . The optimal approach of managing pregnancy complicated by SCD, that results in improved maternal and fetal outcomes, is yet to be identified.…”

Section: Discussionmentioning

confidence: 99%

“…The optimal approach of managing pregnancy complicated by SCD, that results in improved maternal and fetal outcomes, is yet to be identified. Some experts have tried various interventions, including prophylactic blood transfusion during pregnancy, but no difference was seen in pregnancy outcomes compared with women who were transfused on an episodic basis …”

Section: Discussionmentioning

confidence: 99%

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Pregnancy outcomes in women with sickle‐cell disease in low and high income countries: a systematic review and meta‐analysis

Boafor

Olayemi

Galadanci

et al. 2015

BJOG

115

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Background Pregnancy in women with sickle-cell disease (SCD) is associated with increased adverse outcomes. Findings on the association between SCD and adverse pregnancy outcomes are conflicting, and the results do not address whether these associations are similar in both low-and high-income countries.Objectives We conducted a systematic review and meta-analysis to evaluate pregnancy outcomes associated with SCD.Search strategy The MEDLINE database was searched using medical subject headings (MeSH) and keywords for articles on pregnancy outcomes in women with SCD.Selection criteria We used full research articles published in English that compared women with SCD with women who did not have SCD, as controls.Data collection and analysis Data were abstracted and analysed using comprehensive Meta-analysis 2.2. The primary outcomes were intrauterine growth restriction and perinatal mortality. Secondary outcomes were rates of caesarean sections, preeclampsia, eclampsia, postpartum haemorrhage, maternal mortality, prematurity, and low birthweight. Random-effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (95% CIs).Main results Sixteen studies met all of the selection criteria and were included in the analysis. SCD was associated with intrauterine growth restriction (pooled OR 2.79, 95% CI 1.85-4.21), perinatal mortality (pooled OR 3.76, 95% CI 2.34-6.06), and low birthweight (pooled OR 2.00, 95% CI 1.42-2.83). SCD was also associated with an increased risk of pre-eclampsia (pooled OR 2.05, 95% CI 1.47-2.85), maternal mortality (pooled OR 10.91, 95% CI 1.83-65.11, P = 0.009), and eclampsia (pooled OR 3.02, 95% CI 1.20-7.58).Conclusion Pregnancy in women with SCD is associated with increased risks of adverse perinatal and maternal outcomes in both low-and high-income countries.Keywords Maternal and perinatal outcome, pregnancy, sickle-cell disease.Tweetable abstract This meta-analysis showed worse pregnancy outcomes in women with sickle-cell disease compared with controls.Please cite this paper as: Boafor TK, Olayemi E, Galadanci N, Hayfron-Benjamin C, Dei-Adomakoh Y, Segbefia C, Kassim AA, Aliyu MH, Galadanci H, Tuuli MG, Rodeghier M, DeBaun M, Oppong SA. Pregnancy outcomes in women with sickle-cell disease: a systematic review and meta-analysis. BJOG 2016;123:691-698.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pregnancy outcomes in women with sickle‐cell disease in low and high income countries: a systematic review and meta‐analysis

Boafor

Olayemi

Galadanci

et al. 2015

BJOG

115

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“…118 Pregnancy is associated with a higher rate of SCD-related complications, including pain episodes, ACS, and death. 116,117,119,120 In addition, women with SCD, compared with the general population, are at increased risk for pregnancy-related complications, such as preeclampsia and miscarriage. 116,117 The rate of fetal complications, including low birth weight, small size for gestational age, and stillbirth, is also higher in pregnant women with SCD, likely because of impaired blood flow to the placenta.…”

Section: Remarksmentioning

confidence: 99%

American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support

et al. 2020

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Background: Red cell transfusions remain a mainstay of therapy for patients with sickle cell disease (SCD), but pose significant clinical challenges. Guidance for specific indications and administration of transfusion, as well as screening, prevention, and management of alloimmunization, delayed hemolytic transfusion reactions (DHTRs), and iron overload may improve outcomes. Objective: Our objective was to develop evidence-based guidelines to support patients, clinicians, and other healthcare professionals in their decisions about transfusion support for SCD and the management of transfusion-related complications. Methods: The American Society of Hematology formed a multidisciplinary panel that was balanced to minimize bias from conflicts of interest and that included a patient representative. The panel prioritized clinical questions and outcomes. The Mayo Clinic Evidence-Based Practice Research Program supported the guideline development process. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to form recommendations, which were subject to public comment. Results: The panel developed 10 recommendations focused on red cell antigen typing and matching, indications, and mode of administration (simple vs red cell exchange), as well as screening, prevention, and management of alloimmunization, DHTRs, and iron overload. Conclusions: The majority of panel recommendations were conditional due to the paucity of direct, high-certainty evidence for outcomes of interest. Research priorities were identified, including prospective studies to understand the role of serologic vs genotypic red cell matching, the mechanism of HTRs resulting from specific alloantigens to inform therapy, the role and timing of regular transfusions during pregnancy for women, and the optimal treatment of transfusional iron overload in SCD.

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“…The increased incidence of pain may be due to the physiologic stress of carrying a pregnancy, dehydration, or infection. 6 The American College of Obstetricians and Gynecologists suggests opioids for pain management; however, a Cochrane review highlights the absence of randomized trials supporting their efficacy in this population. 1,2 Thus, additional analgesics must be considered.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Use of Ketamine for Pain Control With Sickle Cell Crisis in Pregnancy

et al. 2018

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Sickle cell crises occur frequently during pregnancy and are difficult to treat, even with high-dose opioids. Analgesia with ketamine has been suggested as an alternative, but its use during pregnancy is underreported. Two pregnant patients with uncontrolled sickle cell pain were treated with ketamine. Patient A reported no decrease in her pain, but her opioid requirements decreased. Patient B's pain resolved during ketamine administration. No serious maternal or neonatal adverse effects occurred. Ketamine may be considered as an adjunct analgesic in pregnant patients with sickle cell pain, although prospective clinical data are needed to fully assess its efficacy.

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Sickle cell crisis and pregnancy

Cited by 29 publications

References 34 publications

Pregnancy outcomes in women with sickle‐cell disease in low and high income countries: a systematic review and meta‐analysis

Pregnancy outcomes in women with sickle‐cell disease in low and high income countries: a systematic review and meta‐analysis

American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support

Evaluating the Use of Ketamine for Pain Control With Sickle Cell Crisis in Pregnancy

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