2012, Number 4
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Rev Cubana Hematol Inmunol Hemoter 2012; 28 (4)
Sickle cell disease and pregnancy. Experience at the Instituto de Hematologia e Inmunología, Cuba
Hernández-Padrón C, del Loreto TM, Espinosa-Estrada E, Ramón-Rodríguez LG, Ávila-Cabrera OM, Pujadas-Ríos X, Agramonte-Llanes O
Language: English
References: 24
Page: 416-422
PDF size: 113.00 Kb.
ABSTRACT
Pregnancy in women with sickle cell disease (SCD) is a high-risk situation
associated with increased incidence of maternal and fetal morbidity and mortality.
In Cuba, the maternal care program includes the primary level and the gestational
age at booking is before the 12 week of gestation and all deliveries are institutional.
All pregnant women with SCD in La Habana are attended at the
Institute of
Hematology and Immunology (IHI) by a multidisciplinary team and labor takes
place at the obstetrics service of the
General Hospital next to the IHI. From January
2000 to December 2009, 68 pregnant women with SCD were attended in labor; the
frequency of the visits is every two weeks from gestational age at booking until
week 32 of pregnancy and weekly until week 36 when they are hospitalized, in
week 38 induction of labor is made. Patients were hospitalized upon the appearance
of any event and in such cases induction of labor was made in week 36, if fetus was
mature. The fetal well-being was evaluated starting from week 28 and every two
weeks until childbirth. Non prophylactic blood transfusion or prophylactic exchange
transfusions were indicated as this depends on the criteria of attending team; only
16 patients presented alert signs of requiring blood transfusion, 4 requiring blood
exchange transfusions. All these procedures were carried out in the third trimester
of pregnancy; 47 patients required caesarea indicated by the obstetrician; 17
newborns were underweight but only one with low apgar score. Two fetal deaths
occurred and one new born had early neonatal death. Only one maternal death was
reported.
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