Pregnancy Outcomes Among Patients with Sickle Cell Disease

Abstract

Background: Pregnancy is a serious problem for women with sickle cell disease. It is associated with an increased risk of maternal and fetal morbidity and mortality. Objective: The objective of this study is to study and assess the pregnancy outcomes among women with sickle cell disease. Materials and Methods: This was a five-year retrospective study of the outcome of pregnancy in 56 women with sickle cell disease at the University of Abuja Teaching Hospital between January 1, 2014 and December 31, 2018. Pertinent information was obtained from labour, postnatal, and neonatal ward records as well as theatre records. The relevant demographic data such as age, gravidity/parity, concomitant medical/obstetric conditions, mode of delivery and maternal and neonatal outcomes were retrieved, documented and analyzed. The pregnancies were characterized by high maternal and fetal morbidity and mortality. Maternal complications noted were maternal mortality, hypertensive disorders of pregnancies, sickle cell crises and infections. Fetal complications included are intrauterine fetal deaths, stillbirths, prematurity, low birth weights, fetal distress and asphyxia. The case notes of the patients were retrieved and analyzed using the statistical package for social science SPSS version 21. The results were presented and discussed using simple percentages and tables. Results: There were a total of 9, 682 deliveries during the study period, out of which 56 (0.6%) of those women were those with sickle cell disease. Fifty-two (92.1%) of the women had the genotype HbSS while 4(7.9%) were of the genotype HbSC. The age range was from 18 to 39 years with the mean age being 27.4 ± 4.7 years. Fifty-three (94.6%) of them were booked at our facility with the gestational age at booking ranging from 10 to 35 weeks gestation (Mean: 15.8 ± 1.3 weeks). The Antenatal complications included vaso-occlusive crises 24 (42.9%), Anaemia 22 (39.3%), Malaria 20 (35.7%), pregnancy-induced hypertension 18 (32.1%), Preeclampsia and eclampsia 11 and 8 (11.7% and 8.9%), pyelonephritis 10 (17.9%). The majority of the women in this study (58.9%) had vaginal delivery while 41.1% had a caesarean section. About (17) 30.4% delivered before 37completed weeks of gestation. Birth weight below 2500g was noted to have occurred in (17) 30.4% of the neonates. Neonatal complications included prematurity 17 (30.4%), fetal distress 7 (12.5%) and birth asphyxia 5 (8.9%). Overall, there were four maternal deaths that occurred during this study (7.1%) while 9 (16.1%) of the babies suffered perinatal mortality. Conclusion: The study showed that sickle cell disease in pregnancy is quite common in the region and is associated with adverse pregnancy outcomes for the sufferers of this medical condition. It does become pertinent that health workers should be knowledgeable and skilled in the management of these patients and that emphasis on effective antenatal care and skilled supervised deliveries, as well as female and health education to these women, may be improved to further reduce the prevalence of the maternal and neonatal complications associated with pregnancy in sickle cell disease patients.