Managing sickle cell disease in pregnancy, the success and the challenges: Our experience in a semi‑urban tertiary health‑care facility, Southwest, Nigeria

Abstract

Background: Pregnancy complicated by sickle cell disease (SCD) is known to be associated with poor maternal and fetal outcomes. However, the challenges encountered in managing these patients in the rural and semi‑urban areas are yet to be evaluated by many of these studies.

Objectives: The objective of the study is to determine the maternal and fetal outcomes of pregnancy complicated by SCD, the importance of the pregestational counseling and care and the challenges faced by the health‑care givers in giving them optimal care in Nigeria, especially in rural and semi‑urban settings.

Materials and Methods: This is a prospective study. All diagnosed SCD pregnant women seen between May 2013 and April 2016 were recruited into the study, after taking informed consent from them. They were all subjected to the standard management of sickle disease in pregnancy. The antenatal, intrapartum, immediate postdelivery and the puerperal events were documented in structured obstetric data sheets. The information obtained from these data sheets were used to generate a database for analysis.

Results: The total number of the patients recruited into this study was 54. They were all booked patients or those referred from other centers with adequate antenatal records. The incidence of SCD in this study was 1.15% (HBSS; 0.49%, HBSC; 0.55%, and HBCC; 0.11%). The mean maternal ages at booking were 26.35 ± 5.76, 27.12 ± 3.28, and 27.004 ± 0.69 years for HBSS, HBSC, and HBCC, respectively. The mean gestational ages at delivery were 37.43 ± 1.36, 38.58 ± 1.21, and 35.80 ± 0.84 weeks for HBSS, HBSC, and HBCC, respectively. The antenatal bookings were all in the second and third trimesters. Similarly, only 10 (39.96%) had pregestational counseling and care before pregnancy. The patients were mostly middle social class status and with poor antenatal clinic visits.

Discussion: Poor maternal and fetal outcomes were seen more in HBSS than HBSC and HBCC. However, statistical analysis showed statistically significant differences only in the prematurity, preterm labor, and the mean fetal weights. Factors such as pregestational counseling and care, social class, parity, and early antenatal booking play important roles in achieving optimal care and excellent outcomes.

Conclusion: Many authors documented poor maternal and fetal outcomes in pregnancies complicated by SCD. The focus now should be identifying factors that may militate against achieving excellent results from the optimal care of these patients. This we have initiated in this study.

Keywords: Antenatal blood transfusion; postpartum blood transfusion; pregestational counseling and care; sickle cell disease in pregnancy; social class; vaso‑occlusive crises