Pregnancy in a Sickle Cell Disease Patient: A Nightmare!

Abstract

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. How to cite this article Doshi B, Mehendale MA, Nayak AH, et al. Pregnancy in a Sickle Cell Disease Patient: A Nightmare!. J South Asian Feder Obst Gynae 2020;12(5):323–325.