Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 12 , ISSUE 5 ( September-October, 2020 ) > List of Articles

CASE REPORT

Pregnancy in a Sickle Cell Disease Patient: A Nightmare!

Bhavya Doshi, Snehal Mulik

Citation Information : Doshi B, Mulik S. Pregnancy in a Sickle Cell Disease Patient: A Nightmare!. J South Asian Feder Obs Gynae 2020; 12 (5):323-325.

DOI: 10.5005/jp-journals-10006-1821

License: CC BY-NC 4.0

Published Online: 23-03-2021

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Aim: To discuss the effect of pregnancy in sickle cell disease (SCD) patients and its associated complications. Background: Sickle cell disease is the most common inherited disorder worldwide and in certain regions of India with varying clinical severity and potentially serious complications. Sickle cell disease can magnify complications during pregnancy and in turn negatively influence the pregnancy outcomes. The physiological adaptations during pregnancy that occur in the circulatory, hematologic, renal, and pulmonary systems can overburden organs that already have chronic injuries secondary to SCD, thus increasing the rate of obstetric complications like miscarriage, anemia, preeclampsia, worsening of vaso-occlusive crisis, and acute chest syndromes. Case description: A 23-year-old Indian primigravida patient, known case of SCD with anemia and splenic infarct with h/o multiple blood transfusions. The patient presented at 12 weeks with intrauterine fetal demise and was medically aborted. The post-abortion patient was posted for splenectomy as she had episodes of hemolytic jaundice. Post-splenectomy patient further developed bowel obstruction and thrombus formation in the infrarenal part of inferior vena cava (IVC). She was again operated and for obstruction and the band was removed. For thrombi, patient was given low molecular weight heparin (LMWH). The patient was finally discharged on tb. hydroxyurea and other antibiotics. Conclusion: The higher rate of complications occurs in women with sickle cell crisis exaggerated by underlying factors such as long-term anemia and pregnancy increases the risk further. Thus, a multidisciplinary approach with regular follow-up of SCD patients since the time of preconceptional time is important to avoid pregnancy-related complications and also for a better pregnancy outcome. Clinical significance: The physiological changes of pregnancy like increased blood volume, increased metabolic demand, increased blood viscosity, and hypercoagulability get aggravated in SCD patients leading to increased incidence of complications. Prepregnancy anemia and other complications of a mother can further affect the outcome, thus preconceptional counseling is a crucial part of management.


HTML PDF Share
  1. Global burden of sickle cell anaemia in children under five, 2010–2050: modelling based on demographics, excess mortality, and interventions. PLoS Med 2013;10(7):e1001484. DOI: 10.1371/journal.pmed.1001484.
  2. Sickle cell disease and pregnancy. Blood Rev 1995;9(3):157–164. DOI: 10.1016/0268-960X(95)90021-7.
  3. Sickle cell disease in pregnancy. Obstet Gynecol Clin N Am 2010;37(2):223–237. DOI: 10.1016/j.ogc.2010.02.015.
  4. Pregnancy in sickle cell disease. Obstet Gynecol 1986;67(2):217–228. DOI: 10.1097/00006250-198602000-00012.
  5. Genetic atlas of Indian Tribes. Bombay: Institute of Immunohaematology (ICMR); 1987.
  6. Genetics and epidemiology of sickle cell anemia in India. Indian J Med Sci 1988;42:218–222.
  7. Pregnancy in sickle cell disease in the UK. Br J Obstet Gynaecol 1983;90(2):112–117. DOI: 10.1111/j.1471-0528.1983.tb08893.x.
  8. Sickle cell disease. Studd J, ed. Progressin Obstetrics and Gynaecology 1. Edinburgh: Churchill Livingstone; 1981. pp. 70–78.
  9. Outcome of pregnancy in homozygous sickle cell disease. Obstet Gynecol 2004;103(6):1278–1285. DOI: 10.1097/01.AOG.0000127433.23611.54.
  10. Severe sickle cell disease and pregnancy. Systematic prophylactic transfusions in 16 cases. Med Trop (Mars) 2002;62(6):603–606.
  11. Management of high risk pregnancy in sickle cell disease by a strategy of prophylactic red cell transfusion or automated red cell exchange. Transfus Clin Biol 2007;14(4):386–392. DOI: 10.1016/j.tracli.2007.10.002.
  12. Prophylactic versus selective blood transfusion for sickle cell disease in pregnancy. Cochrane Database Syst Rev 2016;12(12):CD010378. DOI: 10.1002/14651858.CD010378.pub3.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.