Obstetric Challenges Of Sickle Cell Disease In Pregnancy

Abstract

Background: Sickle cell disease in pregnancy is associated with an increased risk of medical, obstetric and fetal complications. Maternal complications are widely varied, notably includes anaemia, pulmonary hypertension, antepartum haemorrhage, premature labour and death. Fetal complications include intrauterine growth restriction, premature delivery, and perinatal mortality. Method: A list of patients who presented with sickle cell diseases over the 3-year period were generated from the antenatal clinic and in-ward patients. Information on maternal and neonatal events was extracted from their medical records and analysis was done with SPSS for windows version 19.0. Result: 9,346 pregnant women were managed over the study period, 32 (0.34%) had SCD related complications. The average patient age was 26.30years (range 19-37). 93.33% of the patients had a blood transfusion. The genotype of the patients, (HbSS, HbSC), did not significantly influence the need for blood transfusion (p=0.017). The mode of delivery did not significantly influence the need for transfusion. (p=0.083). Stillbirth delivery rate was 8.88%(n=4). The maternal mortality ratio is 11,111 per 100,000 live births. Conclusion: Pregnancy in sickle cell disease is associated with an abysmally high maternal mortality ratio. This is about twenty times the national average. The need for blood transfusion is high in all the variants of the disease. There is therefore a need to draw attention to critical care during labour and delivery in Sickle cell disease patients in resource-constrained settings with a view to improving maternal and perinatal outcome.