Fetomaternal Outcome of Sickle Cell Disease

Objective: Sickle cell hemoglobinopathies are the most prevalent inherited blood disorders.According to the World Health Organization (WHO), around 5% of the global population carries a gene for an inherited hemoglobin (HB) disorder.This study is to identify the various maternal outcomes among pregnant women with sickle cell disease (SCD) at a tertiary healthcare center and to identify the various fetal outcomes among babies born to pregnant women with SCD at a tertiary healthcare center.It will also help us in assessing the role of proper antenatal care (ANC) to reduce maternal and perinatal mortality in pregnant women with SCD and in the neonate.Materials and methods: This cross-sectional study was conducted over 18 months at a tertiary care hospital in Burla, Sambalpur.A total of 122 pregnant women diagnosed with SCD were included.Exclusion criteria encompassed pre-existing renal or liver disease, multifetal gestation, and other conditions potentially confounding the study.Results: The mean age of homozygous sickle cell disease (HbSS) type known as SCD (SS) mothers was 26.26 years.The maximum number of pregnant mothers was in the 21-25 age-group.The mean gravida was 1.9 in SS mothers, and most of the antenatal patients in this study were identified as primigravidae.The mean parity was noted to be 1.43 in SS mothers.Previous abortion history of one spontaneous abortion was seen to be 95.08% of SS mothers, and two or more was 4.92% in SS mothers.The mean body mass index (BMI) was 19.43 kg/m 2 in SS mothers.Mean Hb was 8.8 gm% in SS mothers.It was observed in the study that 2.01% SS mothers had severe to very severe anemia, and 62.01% had moderate anemia.A total of 66.2% of SS mothers required blood transfusion (BT).The mean serum bilirubin (S. bilirubin) level in SS mothers was 1.50 mg%.The maximum number of pregnant mothers in all groups was in the S. bilirubin group of 0-5.0 mg%.The presence of urine albumin (2+ and 3+) was seen in 14.7% of SS mothers.The study showed that hypertensive disorder of pregnancy (HDP) was seen in 10.5% of SS mothers.The presence of urine albumin also correlated with HDP.The maternal complications, such as crisis, were seen in 8.5% of SS mothers.The postpartum hemorrhage (PPH) and mortality in the SS mothers were 3.2-1.6%,respectively.Maternal mortality was seen in 2 (1.6%) cases of SS mothers, out of which 1 (50%) was attributed to crisis [vaso-occlusive crisis (VOC) and acute chest syndrome (ACS)], and the other death was attributed to co-morbidities like eclampsia and other complications like fetal growth restriction (FGR) were seen in 14.1% of SS mothers.The number of vaginal deliveries (VDs) in the case of SS mothers was 23.7%.The number of pregnant mothers who underwent lower segment cesarean section (LSCS) was 72.21%, and instrumental delivery was 4.09% in SS mothers, respectively.The incidence of preterm deliveries in SS mothers was 18.86%.Low-birth-weight (LBW) babies in SS mothers accounted for 31.9%.There was a low APGAR score in the babies of SS mothers, which is 13.6%.It was observed that 12 (75%) neonates delivered by LSCS and 4 (25%) neonates delivered by VD to SS mothers had low APGAR scores, respectively.Stillborn babies (fresh and macerated) were found in 4% of SS mothers.Total perinatal death was found in 8.1% of babies.It was observed that special newborn care unit (SNCU) admissions were higher among babies of SS mothers, which was 41.9%.Neonatal complications like hypoxic ischemic encephalopathy (HIE) were at 5.98%, anemia was 7.69%, and jaundice was at 7.69% in babies born to SS mothers.Septicemia was found in 5.12% of babies born to SS mothers, respectively. Conclusion:Our study shows that close monitoring of individual pregnancy with SCD can result in a good fetomaternal outcome.Therefore, all these cases require special attention in view of the correction of anemia by BT and prevention of vaso-occlusive complications of SCD, which will give a better prognosis.Adverse fetal outcomes are more common with SCD than general population.Fetal complications are mainly jaundice, neonatal anemia, HIE, and neonatal death.A multidisciplinary approach is required for the comprehensive management of women with SCD so that complications can be dealt with carefully.