Pregnancy in Sickle Cell Disease, with Human-Immunodeficiency Virus (HIV) and Obstructive Jaundice

Abstract

Sickle cell disease (SCD) is an autosomal recessively inherited hemoglobinopathy whose pathology involves tissue anoxia occasioned by abnormally shaped red cells. Although its burden is higher in Sub-Saharan Africa, an improvement in the quality and accessibility of healthcare has led to a prolonged lifespan for the affected. In effect, as more SCD patients conceive, the impact of the disorder on pregnancy continues to unravel. Its ramifications on conception and pregnancy include intrauterine growth restriction, fetal death, miscarriages, and subfertility. Also, sickling crisis in labour, postpartum haemorrhage, pre-eclampsia, and the need for caesarian delivery, often ensue peripartum. Unpacking pregnancy in SCD from the antenatal care perspective, intrapartum considerations, and continuity of care in the postnatal period is thus an essential concept for all practitioners to improve care provision for these mothers. Through the lenses of a case of pregnancy in SCD, HIV infection, and obstructive jaundice, our review journeys the complex course of care for a patient for 7weeks in our facility. We outline concepts of comprehensive patient care for pregnancy in SCD based on currently available evidence, and how they were applied to ensure optimal outcomes for the fetus and mother, whose case posed a unique challenge to the obstetric team.