Maternal–fetal prognosis of major sickle cell disease in pregnant women at a university hospital in a low–middle-income country
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Abstract
Background. Sickle cell disease (SCD) is a common genetic disease in sub-Saharan Africa. The condition affects more than 7% of pregnant women worldwide, with complications including severe infections, vital organ damage, respiratory problems, bone marrow suppression and a high rate of maternal or fetal death.
Objective. To evaluate the prevalence, management and maternal–fetal prognosis of pregnancies in women with major SCD.
Methods. A prospective and descriptive study was conducted in the gynaecology and obstetrics department of the university hospital of Cocody, Abidjan, in Cote d’Ivoire over two years. Records of all pregnant women with homozygous SCD who had given birth or were followed up in the unit were reviewed. Women with an HbAA or HbAS genotype or any other normal electrophoretic profile or history of renal disease were excluded.
Results. Out of 14 819 delivery records, 118 (0.8%) women presented with an abnormal haemoglobin profile; 75 were classified as having major SCD (0.51%). The majority of women (82.7%) were younger than 35 and 68% worked in the informal sector. About a third (37.3%) had no formal education. Heterozygous HbSC profiles were the predominant (88%) presenting form; HbSS genotypes were found in 12% of cases. The occurrence of complications during pregnancy was significant (44%).
Conclusion. SCD in pregnancy is associated with an increased risk of maternal and fetal complications. Accurate and rigorous monitoring of these pregnancies by a multidisciplinary team, together with improved patient awareness and education, is required to reduce maternal and fetal health risks.
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