Document Detail


Pregnancy in sickle cell disease in the UK: results of a multicentre survey of the effect of prophylactic blood transfusion on maternal and fetal outcome.
MedLine Citation:
PMID:  8652484     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine the outcome of pregnancies complicated by sickle cell disease in the UK during 1991-1993 and the effect of prophylactic blood transfusion programmes on maternal and fetal outcome. DESIGN: A multicentre study. SUBJECTS: Eighty-one pregnancies complicated by sickle cell disease and 100 pregnancies from women of black African descent without haemoglobinopathies to act as a comparative group. Pregnancies complicated by sickle cell disease were divided by the type of haemoglobinopathy and also by transfusion regimen. MAIN OUTCOME MEASURES: Antenatal and postnatal complications of sickle cell disease, proteinuric hypertension, preterm delivery, emergency delivery by caesarean section, fetal distress, birthweight, perinatal and maternal mortality. RESULTS: There were two maternal deaths in the 81 pregnancies and the perinatal mortality rate was 60/1000. Antenatal sickling complications occurred in 46.2% of pregnancies and postnatal sickling complications occurred in 7.7% of pregnancies. Pregnancies complicated by sickle cell disease were significantly more likely to be associated with anaemia, preterm delivery, proteinuric hypertension, birthweight below the 10th centile and caesarean section as an emergency procedure than the comparative group. Severe sickling complications occurred more commonly in the third trimester and there was some evidence that a prophylactic transfusion programme reduced the risk of this. Prophylactic transfusion did not improve obstetric outcome when compared with those pregnancies that were untransfused. CONCLUSIONS: Sickle cell disease remains a severe complicating factor to pregnancy and perinatal mortality and maternal mortality rates in the UK have increased since last reported. A policy of exchange transfusing all women with homozygous sickle cell disease (HbSS) from 28 weeks gestation is recommended to reduce the risk of maternal complications in the third trimester and puerperium. There remains a role for earlier prophylactic blood transfusion programmes in women with poor obstetric and haematological histories.
Authors:
R J Howard; S M Tuck; T C Pearson
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  British journal of obstetrics and gynaecology     Volume:  102     ISSN:  0306-5456     ISO Abbreviation:  Br J Obstet Gynaecol     Publication Date:  1995 Dec 
Date Detail:
Created Date:  1996-07-31     Completed Date:  1996-07-31     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  7503752     Medline TA:  Br J Obstet Gynaecol     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  947-51     Citation Subset:  AIM; IM    
Affiliation:
University Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK.
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MeSH Terms
Descriptor/Qualifier:
Anemia, Sickle Cell / therapy*
Birth Weight
Blood Transfusion* / adverse effects
Cesarean Section
Female
Great Britain
Hemoglobin A / analysis
Humans
Infant Mortality
Infant, Newborn
Lung Diseases / etiology
Obstetric Labor, Premature / etiology,  prevention & control
Pregnancy
Pregnancy Complications, Hematologic / therapy*
Pregnancy Outcome
Pregnancy, Multiple
Chemical
Reg. No./Substance:
9034-51-9/Hemoglobin A

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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