No abstract

Purpose of reviewPregnancy exacerbates sickle cell disease (SCD) and is associated with increased frequency and severity of complications resulting in high levels of maternal and fetal morbidity and mortality. We review recent recommendations for managing SCD in pregnancy. Recent findingsAn updated pathobiological model of SCD now attributes the clinical picture to a vicious cycle of four major cellular disturbances. Management decisions should be guided by an understanding of this upgraded model. Red cell transfusions are a key therapeutic intervention used in managing several acute and chronic complications. Transfusion however has significant drawbacks. The American Society of Hematology recently published transfusion guidelines to support care providers. SummaryPatients should be managed by a multidisciplinary and experienced team. The perioperative episode is a recognized period of disease exacerbation and informed anesthetic management can contribute to improved patient outcomes.

The crucial role of anaesthesia in improving outcomes in obstetrics has received renewed attention over the last few years. In 2016, Sobhy and colleagues presented the first systematic review of anaesthesia-related maternal mortality in lowincome and middle-income countries (LMICs).1 They found that anaesthesia contributed to 2.8% of all maternal deaths in LMICs. This is a relatively small percentage and may be superficially reassuring to anaesthesia providers; however, the overall frequency of anaesthesia-related maternal death was 300-fold higher for neuraxial anaesthesia and 900-fold higher for general anaesthesia than that reported for the USA.2 In contrast to other causes of maternal mortality, anaesthesia does not represent a disease or pathological condition; deaths related to anaesthesia are iatrogenic. The underlying causes of death in the study by Sobhy and colleagues included airway-related complications (45%), pulmonary aspiration (31%) and staff competencies and equipment issues (27%). It therefore behoves all anaesthesia providers who care for obstetric patients to scrutinise practice and seek ways to reduce anaesthesia-related morbidity and mortality. This edition of SAJAA features four articles of direct relevance to obstetric anaesthesia that provide valuable insight into aspects of care and strategies for quality improvement.