Pre conception care in sickle cell Flashcards
Pregnancy risks ass with sickle cell
- Perinatal mortality
- Premature labour
- Fetal growth restriction
- Acute painful crises during pregnancy
Maternal risks ass with sickle cell
- Spontaneous miscarriage
- Antenatal hospitalisation
- Maternal mortality
- Delivery by caesarean section
- Infection
- Thromboembolic events
- Antepartum haemorrhage
Screening for pulmonary hypertension with echocardiography in sickle cell
- Every year
- Tricuspid regurgitant jet velocity of more than 2.5 m/second is associated with a high risk of pulmonary hypertension
Blood pressure and urinalysis in sickle cell
- Identify women with hypertension and/or
proteinuria - Renal and liver function tests should be performed annually to identify sickle nephropathy and/or deranged hepatic function
Retinal screening in sickle cell
- Proliferative retinopathy is common in patients with SCD, especially patients with HbSC, and can lead to loss of vision
- No evidence for regular screening but should be done once before pregnancy
Iron overload in sickle cell
- T2* cardiac magnetic resonance imaging
- Aggressive chelation
Screening for red cell antibodies in sickle cell
More likely in patients with multiple transfusions
Conditions that need genetist and prenatal diagnosis with partner testing
- HbS
- β thalassaemia
- O-Arab
- HbC
- D-Punjab
Conditions that MAY need further investigation with genetist
- DB thalassaemia
- Lepore
- HbE
- Hereditary persistence of fetal hemoglobin (HPFH)
Antibiotic prophylaxis in sickle cell
- Hyposplenic and are at risk of infection, in particular from encapsulated bacteria such as Neisseria meningitides, Streptococcus pneumonia and Haemophilus influenzae
- Penicillin prophylaxis
- H. influenza type b and the conjugated meningococcal C vaccine as a single dose
- Hepatitis B vaccination
Vit supplements and sickle cell
Folic acid 5 mg
Hydroxycarbamide (hydroxyurea) in sickle cells
- Stop 3 months before conception
- Reduces painful crisis but teratogenic
Indication for blood transfusion in pregnancy
- Women with previous serious medical, obstetric or fetal complications:Exchange or top-up transfusion may be indicated depending on clinical situation
- Women who are on a transfusion regimen before pregnancy :Transfusion should be continued during pregnancy
- Twin pregnancies: Prophylactic transfusion should be considered owing to the high rate of complications in these women
- Acute anaemia: Top-up transfusion
- Acute chest syndrome or acute stroke: Exchange transfusion
Painful crisis in sickle cell during pregnancy
- 27% and 50% of women
- Avoidance of precipitant factors
- Mild pain may with rest, oral fluids and paracetamol or weak opioids. NSAIDs should be used only between 12 and 28 weeks of gestation
- In acute pain, analgesia within 30 minutes and should be effective within the hour
- Pethidine can give seizures to sickle pts
