gynecology and obstetrics
Anemia in Pregnancy
Hemoglobinopathies in Pregnancy
During pregnancy, hemoglobinopathies, particularly Sickle Cell Disease , Preexistingsickle cell disease,particularly if severe, increases risk of the following: Maternal infection (most often, Overview of Pneumonia , Hypertension in Pregnancy None Heart Failure (HF) None Pathophysiology None Small-for-Gestational-Age (SGA) Infant None Preterm Labor None Small-for-Gestational-Age (SGA) Infant None Anemia almost always becomes more severe as pregnancy progresses. Sickle cell trait increases the risk of UTIs but is not associated with severe pregnancy-related complications. Treatment of sickle cell disease during pregnancy is complex. Painful crises should be treated aggressively. Prophylactic exchange transfusions to keep Hb A at≥60% reduce risk of hemolytic crises and pulmonary complications, but they are not routinely recommended because they increase risk of transfusion reactions, hepatitis, HIV transmission, and blood group isoimmunization. Prophylactic transfusion does not appear to decrease perinatal risk. Therapeutic transfusion is indicated for the following: Symptomatic anemia Heart failure Severe bacterial infection Severe complications of labor and delivery (eg, bleeding, sepsis) Hb S-C diseasemay first cause symptoms during pregnancy. The disease increases risk of pulmonary infarction by occasionally causing bony spicule embolization. Effects on the fetus are uncommon but, if they occur, often include fetal growth restriction. Sickle cell–beta-thalassemiais similar to Hb S-C disease but is less common and more benign. Alpha-thalassemiadoes not cause maternal morbidity, but if the fetus is homozygous, hydrops and fetal death occur during the 2nd or early 3rd trimester. 