Evidence-based obstetric management of women with sickle cell disease in low-income countries

Abstract

Pregnancy in women with sickle cell disease (SCD) is fraught with complications, some of which are life-threatening. Managing pregnancy in these women can be challenging, especially with poor resources, which is often the case in low-income countries. In Nigeria, for instance, up to 90% of patients pay out of pocket for medical care due to the poorly developed health insurance system, and this worsens the morbidity and mortality associated with this condition. We describe a pragmatic approach to routinely managing pregnant women with SCD in the antenatal period, showing the feasibility of effective management of these high-risk pregnancies in limited-resource settings. We also present the case of a pregnant Nigerian woman with SCD who has intrauterine growth restriction (IUGR) and acute chest syndrome (ACS), conditions that are life-threatening for the fetus and the mother, respectively, and require prompt intervention. We highlight how we successfully managed this woman in a cost-effective manner by employing relatively inexpensive tests for diagnosis and treating her effectively with oxygen, appropriate antibiotics and manual exchange blood transfusion for the ACS, and finger pulse oximeters to monitor oxygen saturation. We explore pathophysiological concepts to IUGR in women with SCD and briefly discuss the appropriate mode of delivery, including the options for pain relief in labor.

Manual Exchange Transfusion Role in the Management of a Pregnancy Compromised by Sickle Cell Disease in a Tertiary Hospital in Burkina Faso: A Case Report

“…General advice given to pregnant women with sickle cell disease is to drink plenty of water, avoid extreme temperatures, and seek immediate medical attention if they begin to feel unwell. However, they often do not report early due to these constraints in accessing healthcare, and when they do present to the hospital, they are often at an advanced stage of complications [4].…”

“…Moreover, pregnancy often exacerbates sickle cell disease [2]. Manual versus automated exchange transfusion emerges as a promising strategy in resource-limited countries, albeit controversial, to improve obstetric outcomes [2,[4][5][6][7][8]. However, this must be balanced with transfusion side effects, including the risk of alloimmunization and delayed hemolytic reactions [9][10][11].…”

Maternal malnutrition during pregnancy among women with sickle cell disease

“…Medical improvements have allowed women with SCD to reach childbearing age. As this is a multiorgan disease, patients should be monitored for chronic complications and preconceptional counseling has a role in letting them know about the effects of pregnancy 5 , 6 . Since the late 1980s, undernutrition has been identified as a critical feature of SCD 7 .…”