Evaluation of two cases of sickle cell anemia

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Evaluation of two cases of sickle cell anemia and thalassaemia in pregnancy Selda Demircan

Evaluation of two cases of sickle cell anemia and thalassaemia in pregnancy Selda Demircan Sezer Gynecology and Obstetrics Department, Adnan Menderes University, Aydın

Case 1: �G 2 P 1, 33 -year-old, 7 wks' gestation �Heterozygote for beta-thalassemia

Case 1: �G 2 P 1, 33 -year-old, 7 wks' gestation �Heterozygote for beta-thalassemia + hemoglobin S �History: ES / 15 days interval until delivery �Vaso-occlusive crisis in present pregnancy �Exchange transfüsion (5 times) and 2 -3 U ES given/1 month interval until delivery �Hb (hemoglobin): 6, 8 -8, 7 g/d. L

Case 1: �Caesarean section (CS) because of previos CS history �Exchange transfusion made before

Case 1: �Caesarean section (CS) because of previos CS history �Exchange transfusion made before CS � 3440 gr baby, 1 st Apgar score 9, 5 th Apgar score 10, male fetus delivered �Postpartum 2 U ES �No complication

Case 2: �G 2 P 1, 37 -year-old, 17 wks' gestation �Double heterozygote for

Case 2: �G 2 P 1, 37 -year-old, 17 wks' gestation �Double heterozygote for beta-thalassemia and hemoglobin S �Obstetric History: No Exchange transfüsion and intrauterin fetal death at term, DIC �No vaso-occlusive in present pregnancy �Exchange transfüsion 7 times and 2 -3 U ES /1 month interval until delivery

Case 2: �Hb: 6, 2 -8, 4 g/d. L �At 38 th wk planned

Case 2: �Hb: 6, 2 -8, 4 g/d. L �At 38 th wk planned CS made becaause of previos intrauterin death � 2 U exchange transfusion preoperative � 3120 gr, 1 st Apgar score 6, 5 th Apgar score 7, male fetus �Intrapartum 1 U ES �No complication

Pregnancy increases the incidence of sickle cell specific complications: �Anaemia �Vaso-occlusive crisis, abdominal, pulmonary

Pregnancy increases the incidence of sickle cell specific complications: �Anaemia �Vaso-occlusive crisis, abdominal, pulmonary (acute chest syndrome) �Placental thrombosis �Infections (urinary tract infection, pyelonephritis, pneumonia) �Toxemia

Pregnancy increases the incidence of sickle cell specific complications: �Maternal death �High risk of

Pregnancy increases the incidence of sickle cell specific complications: �Maternal death �High risk of spontaneous abortion �Intra-uterine growth retardation �Intra-uterine fetal death �Preterm delivery �Perinatal mortality related to hypoxemia and placental thrombosis

Evaluation of sickle cell anemia �Specific management program �A close multidisciplinary approach for the

Evaluation of sickle cell anemia �Specific management program �A close multidisciplinary approach for the duration of the pregnancy, the delivery and the postpartal period �In tertiary maternal health services level �Blood transfusion depends on teams �Restricted maternal, obstetrical and hematologic indications

Summary �Fetal mortality and morbidity high �Intrauterine growth retardation �Fetal death being the most

Summary �Fetal mortality and morbidity high �Intrauterine growth retardation �Fetal death being the most frequent fetal complications �The rates of prematurity and caesarean section �A multidisciplinary and specific approach �Manage efficiently pregnancy, delivery and postpartum

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