Sickle Cell Disease in Pregnancy Flashcards
Definition of SCD
a group of genetic single-gene autosomal recessive disorders caused by the “sickle” gene, which affects haemoglobin structure.
What are the hemoglobin types of Sickle cell trait
Hb A & Hb S
Ratio of HbA:HbS in Sickle cell trait
60:40
Type of Hb in Sickle Cell Anemia
HbSS
incidence of pregnancies with SCD in UK
100-200 Pregnancies per year
How many children born with SCD worldwide each year
300 K infants
How many children born with SCD in UK each year
300 infants
Average life expectancy of SCD
mid 50s
Is vomiting a red flag in SCD pregnant woman
Vomiting leads to Dehydration which leads Sickle cell Crisis
In SCD it’s importnat to check for End-organ Damage like:
- Echo for PHTN
- BP & Urinalysis for HTN &/or Proteinuria
- Retinal Scan for Proliferative retinopathy
- Cardiac MRI for Iron Overload (if woman has high ferritin or multiple transfusion)
- RFTs & LFTs anually
importance of retinal screening in SCD
for Proliferative Retinopathy (most common in pts with SCD esp. in HbSD)
Medications to be stopped in pregnant women with SCD
- Hydroxycarbamide (hydroxyurea): stop before 3 months of conception - teratogenic
If peregnancy happened before stopping-> stop it, US for malformations (termination isn’t indicated) - ACEI
- ARB
SCD patient is susciptable for what infections
SCD patients are in risk of infection with encapsulated bacteria
1. Strept Pneumococci
2. Hemophilus Influenza
3. Niesseria Gonnorreah
4. Salmonella
Vaccinations that SCD patient shoud have before pregnancy
- H. Influenza vaccine (single dose)
- Conjugated Meningeococcal. C vaccine (single dose)
- Pneumococcal vaccine (every 5 years)
- Hepatitis B vaccine
- Ifluenza and Swine flu vaccine* (annualy)*
US schedule for Pregnant SCD patient
7-9 W: viability scan (in view of inc. risk of miscarriage)
11-14 W: Routine 1st trimester scan
20 W: Anomaly Scan
From 24 W: Serial Growth Scan (every 4W)
Medications to be given in SCD pregnant patient
- Folic Acid 5mg/d
- Penicillin Prophylaxis
- Iron supplements if iron def. anemia
- Low dose Aspirin 75mg/d from 12W -> dec. risk of PE
- Prophylactic LMWH & TED socking in antenatal admissions
- NSAIDs allowed only bet. 12-28 W