Outcome of Pregnancy in Homozygous Sickle Cell Disease

Serjeant, G. R.; Loy, Luana Look; Crowther, Mark; Hambleton, Ian; Thame, M

doi:10.1097/01.aog.0000127433.23611.54

Cited by 167 publications

(160 citation statements)

References 22 publications

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“…The rate of Cesarean delivery in the SCD population is generally higher than in the whole population, 4,6,18 and it varies widely amongst studies, with rates ranging from 15 to 59%. 4,6,7,18 In our study, this rate was 47%. These results suggest that general anesthesia was a risk factor for the occurrence of postnatal sickling complications, while neuraxial anesthesia was not identified as such.…”

Section: Discussionsupporting

confidence: 46%

“…21 However, there was no correlation between the degree of anemia in women with SCD and obstetrical or perinatal complications. 5,7 A high baseline white-cell count has been associated with an increased risk of early death, 21 acute chest syndrome, 23 and neurological complications. 15 A recent study also showed an association between high, steady-state, white-cell count and the severity of SCD in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

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Anesthetic management of pregnant women with sickle cell disease — effect on postnatal sickling complications

Camous

N’da

Etienne‐Julan³

et al. 2008

Can J Anesth/J Can Anesth

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Purpose: Currently, there is no consensus regarding the choice of anesthetic technique for parturients with sickle cell disease (SCD). The aim of the study was to determine the impact of the anesthetic technique on the occurrence of postnatal sickling complications. Methods:We reviewed the charts of all pregnant women with SCD who had given birth in our institution between January 2002 and January 2007. Data related to pregnancy and anesthetic management and complications related, or unrelated, to SCD were recorded. Full blood count and lactate dehydrogenase values were recorded on the day of delivery. Risk factors for postnatal sickling complications were evaluated using a logistic regression analysis to estimate odds ratios (OR) and their 95% confidence intervals (95% CI). Results:Fourteen of the 55 women (24%) experienced at least one postnatal sickling complication. Women who developed postnatal sickling complications were found to have a higher leukocyte count (17.0 ± 6.1 × 10 9 ·L -1 vs 12.8 ± 4.4 ×10 9 ·L -1 , P = 0.008) and a lower hemoglobin level (7.8 ± 1.1 vs 8.9 ± 1.0 g.dL -1 , P = 0.002). General anesthesia (OR = 16.0; 95% CI, 1.6 to 165.6) and a leukocyte count ≥ 15 × 10 9 ·L -1 (OR = 8.4; 95% CI, 1.6 to 44.5) were identified as risk factors. Neuraxial anesthesia and use of ephedrine were not identified as risk factors. There were no deaths. Conclusion: Our study suggests that general anesthesia could be associated with postnatal sickling complications, even when the severity of illness was taken into account.

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Section: Discussionsupporting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Anesthetic management of pregnant women with sickle cell disease — effect on postnatal sickling complications

Camous

N’da

Etienne‐Julan³

et al. 2008

Can J Anesth/J Can Anesth

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“…As a consequence, we did not consider the impact of malaria in any of our models, and both AA and AS individuals were assumed to have the same fitness. An estimate for the relative fitness of women with HbSS was computed as the product of the number of predicted live births [20] and the probability of survival to puberty [21]. It has been documented that there is a delay in onset of puberty and first pregnancy among HbSS compared to HbAA individuals [20]; thus, survival to age 15 years approximates survival to puberty.…”

Section: Models Of Declining Allele Frequencymentioning

confidence: 99%

“…An estimate for the relative fitness of women with HbSS was computed as the product of the number of predicted live births [20] and the probability of survival to puberty [21]. It has been documented that there is a delay in onset of puberty and first pregnancy among HbSS compared to HbAA individuals [20]; thus, survival to age 15 years approximates survival to puberty. An estimate for the relative fitness of men with HbSS was computed as the product of survival to puberty and one minus the cumulative probability of complete erectile dysfunction by the age of 15 years.…”

Section: Models Of Declining Allele Frequencymentioning

confidence: 99%

Predicted declines in sickle allele frequency in Jamaica using empirical data

Hanchard¹,

Hambleton²,

Harding³

et al. 2006

Am. J. Hematol.

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The high frequency of the sickle allele in some parts of Africa is understood to be a consequence of high malarial endemicity. One corollary of this is that the sickle allele frequency should be declining in populations of African ancestry that are no longer exposed to malaria. We have previously shown that there has been no change in sickle allele frequency in malaria-free Jamaica between two large-scale neonatal screening exercises conducted in 1973-1981 and 1995-2003. To evaluate the determinants of, and derive expected values for, sickle allele frequency in Jamaica, local empirical data were used to estimate the parameters of deterministic models of allele frequency decline. We found that although model predictions were broadly consistent with observed values in the 1973-1981 cohort, the predicted change in allele frequency between the two cohorts was larger than the observed, nonsignificant, reduction. Close agreement between predicted and observed values was only achieved by simulating a recent, marked increase in HbSS fitness. Thus, the \unexpected" persistence of the sickle allele in Jamaica may reflect the fact that the actual fitness among SS individuals is higher than that previously realized. If true, our models suggest that without substantial changes in current screening and counseling practice, there will be little \natural" reduction in sickle allele frequency for several hundred years. Better estimates of relative fitness will be helpful in refining these predictions and may aid in assigning health care priorities in Jamaica and the African Diaspora. Am. J. Hematol. 81:817-823, 2006. V V C 2006 Wiley-Liss, Inc.

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“…The most commonly mentioned complications include spontaneous abortions, premature labor, fetal growth retardation, low birth weight, delivery by Caesarean section, infections, thromboembolic events, hypertensive disorders, hemorrhages and retained placenta [5][6][7][8][9][10][11][12][13]. Most studies seem to agree on increased adverse fetal outcomes but there is a wide discrepancy on the occurrence of maternal compli-…”

Section: Introductionmentioning

confidence: 99%

Determinants of adverse pregnancy outcomes among Sickle Cell Disease deliveries at a tertiary hospital in Tanzania from 1999 to 2011

Muganyizi¹

2013

OJOG

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Purpose: Sub-Saharan Africa has the world's largest burden of Sickle Cell Disease (SCD), but due to poor care of SCD in childhood most do not reach reproductive ages. Consequently, due to sporadic cases of SCD in pregnancy, there has been little research attention to the problem in this sub region. This is one of the largest study series of SCD deliveries in Sub-Saharan Africa that aimed to establish the incidence and determinants of adverse pregnancy outcomes. Methods: Data of all deliveries from 1999 to 2011 at Muhimbili National Hospital (MNH) in Tanzania were analyzed. Deliveries of SCD were obtained and categorized according to presence or absence of adverse pregnancy outcomes based on set composite criteria. Using IBM SPSS statistics version 19, bivariate and multivariate logistic regression analyses were done to determine factors that were independently associated with adverse pregnancy outcomes. Statistics with p-value < 0.05 were taken as significant. Results: There were 157,473 deliveries during the study period of which 149 were by SCD mothers. The incidence of adverse pregnancy outcomes was 624 per 1000 SCD deliveries. Compared to SCD without adverse outcomes, those with adverse outcomes were more likely to be referred from lower health facilities (37% versus 12.5%, P = 0.001), of lower mean gestation age (36.3 ± 2.3 versus 38.4 ± 1.4, P < 0.001), more prematurity rate (50.7% versus 10.5%, P < 0.001), made lower mean number of antenatal visits (4.7 ± 2.2 versus 6.2 ± 2.4, P < 0.001) and delivered by cesarean section (31.2% versus 19.6%, P < 0.001). After adjusting for confounding factors, the odds of adverse outcomes were independently increased with referred compared to non-referred women (OR = 4.4; 95% CI: 1.2 -16.8) and among Cesarean section deliveries compared to vaginal deliveries (OR = 4.2; 95% CI: 1.2 -14.6). The risk of adverse outcomes decreased as the gestation age increased (OR = 0.4; 95% CI: 0.3 -0.6). Conclusion: The incidence of adverse pregnancy outcomes in SCD is unacceptably high mainly contributed by poor management and prematurity.

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Outcome of Pregnancy in Homozygous Sickle Cell Disease

Abstract: II-2

Cited by 167 publications

References 22 publications

Anesthetic management of pregnant women with sickle cell disease — effect on postnatal sickling complications

Anesthetic management of pregnant women with sickle cell disease — effect on postnatal sickling complications

Predicted declines in sickle allele frequency in Jamaica using empirical data

Determinants of adverse pregnancy outcomes among Sickle Cell Disease deliveries at a tertiary hospital in Tanzania from 1999 to 2011

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