ISSN: 2148-8274 / E-ISSN: 2587-0084
, Türk Üreme Tıbbı ve Cerrahisi
Dergisi

Turkish Journal of Reproductive Medicine and Surgery

Dernek Sitesi
Kayıtlı İndexler
ORÄ°JÄ°NAL ARAÅžTIRMALAR

Orak Hücreli Anemili Gebelerde Maternal ve Perinatal Sonuçların DeÄŸerlendirilmesi
The Evaluation of Maternal and Perinatal Results in Pregnant with Sickle Cell Anemia
Received Date : 28 Feb 2024
Accepted Date : 02 Jun 2024
Available Online : 04 Jul 2024
Doi: 10.24074/tjrms.2024-102474 - Makale Dili: EN
Turkish Journal of Reproductive Medicine and Surgery. 2024;8(3):91-7.
ÖZET
Amaç: Orak hücreli anemi tanılı gebeliklerin çoğunluğu canlı doğumla sonuçlansa da, bu gebeliklerde fetal vexmaternal komplikasyonlar açısından yüksek risk bulunmaktadır. Bu çalışmadaki amacımız, orak hücrelixanemili gebelerde ve orak hücrelixanemi taşıyıcılığı olan gebelerde maternal vexfetal komplikasyonları değerlendirmektir. Gereç ve Yöntemler: Çalışmamızda Ocak 2016-2022 arasında hastanemize başvuran ve takipleri yapılan; orak hücreli anemili 34 gebe, orak hücreli anemi taşıyıcısı 38 gebe ve 46 sağlıklı gebe retrospektif olarak değerlendirilmiştir. Gebelerin yaş, gebelik haftası, hemogram değerleri, doğum ağırlığı, doğum şekli, doğum haftası, 1-5. Dakika APGAR skorları gruplar arasında karşılaştırılmıştır. Bulgular: Orak hücreli anemisi olan veya taşıyıcı olan gebelerin hemoglobin seviyeleri sağlıklı gebelere göre anlamlı düşük saptanmıştır(p<0.05). Sağlıklı gebelerde doğum ağırlığı, orak hücreli anemisi olan ve taşıyıcılığı olan gebelere göre anlamlı yüksek saptandı(p<0.05). SCA grubunda transfüzyon ve sezaryen sayısı diğer gruplara göre anlamlı olarak yüksek bulundu (p<0,05). SCA grubunda piyelonefrit ve pulmoner emboli varlığı diğer gruplara göre anlamlı olarak yüksek bulundu (p<0.05). SCA grubunda intrauterin gelişme geriliği ve Abruptio plasentae diğer gruplara göre anlamlı olarak daha yüksek bulundu (p<0,05). Sonuç: Orak hücreli anemi tanılı gebelikler yüksek risk grubunda olup deneyimli merkezlerde takip edilmelidir. Klinisyenler olası komplikasyonlar konusunda dikkatli olmalı ve bu komplikasyonların maternal mortaliteye neden olabileceği akılda tutmalıdır.
ABSTRACT
Objective: Although most pregnancies having Sickle Cell Anemia (SCA) result in live births, they pose increased risks for fetal and maternal complications. The purpose of the present study was to examine maternal and fetal complications in pregnant women with SCA and in those who are SCA carriers. Material and Methods: In our study, 34 pregnant women with sickle cell anemia, 38 pregnant women with SCA carriers, and 46 healthy pregnant women who were followed up in our hospital between January 2016 and 2022 were evaluated retrospectively. Pregnant’s age, gestational week, hemogram values, birth weight, delivery method, birth week, 1-5. Minute APGAR-scores were compared between groups. Results: Hemoglobin levels of pregnant with SCA or carriers were found to be significantly lower than healthy pregnant women (p<0.05). Birth weight in healthy pregnant women was found to be significantly higher than in pregnant with sickle cell anemia and carriers (p<0.05). The number of transfusions and cesarean sections in the SCA-group was found to be significantly higher than the other groups (p<0.05). The presence of pyelonephritis and pulmonary embolism in the SCA-group was found to be significantly higher than the other groups (p<0.05). Intrauterine growth retardation and Abruptio placentae was found to be significantly higher in the SCA-group compared to the other groups (p<0.05). Conclusion: Pregnancies diagnosed with SCA are in the high-risk group and should be followed up in experienced centers. Clinicians should be careful about possible complications and keep in mind that these complications may cause maternal mortality.
REFERANSLAR
  1. Chaturvedi S, DeBaun MR. Evolution of sickle cell disease from a life-threatening disease of children to a chronic disease of adults: The last 40 years. Am J Hematol. 2016;91(1):5-14. . [Crossref]  [PubMed] 
  2. Patra PK, Chauhan VS, Khodiar PK, Dalla AR, Serjeant GR. Screening for the sickle cell gene in Chhattisgarh state, India: an approach to a major public health problem. J Community Genet. 2011;2(3):147-51. [Crossref]  [PubMed]  [PMC] 
  3. Bunn HF. Pathogenesis and treatment of sickle cell disease. N Engl J Med. 1997;337(11):762-9. [Crossref]  [PubMed] 
  4. Oteng-Ntim E, Ayensah B, Knight M, Howard J. Pregnancy outcome in patients with sickle cell disease in the UK--a national cohort study comparing sickle cell anaemia (HbSS) with HbSC disease. Br J Haematol. 2015;169(1): 129-37. [Crossref]  [PubMed] 
  5. Serjeant GR. Sickle-cell disease. Lancet. 1997;350(9079):725-30. [Crossref]  [PubMed] 
  6. Smith JA, Espeland M, Bellevue R, Bonds D, Brown AK, Koshy M. Pregnancy in sickle cell disease: experience of the Cooperative Study of Sickle Cell Disease. Obstet Gynecol. 1996;87(2):199-204. [Crossref]  [PubMed] 
  7. Boafor TK, Olayemi E, Galadanci N, Hayfron-Benjamin C, Dei-Adomakoh Y, Segbefia C, et al. Pregnancy outcomes in women with sickle-cell disease in low and high income countries: a systematic review and meta-analysis. BJOG. 2016;123(5):691-8. [Crossref]  [PubMed] 
  8. Oteng-Ntim E, Meeks D, Seed PT, Webster L, Howard J, Doyle P, Chappell LC. Adverse maternal and perinatal outcomes in pregnant women with sickle cell disease: systematic review and meta-analysis. Blood. 2015;125(21):3316-25. [Crossref]  [PubMed] 
  9. Pregnancy, contraception and fertility. In: Standards for the Clinical Care of Adults with Sickle Cell Disease in the UK, 2008. p.59
  10. Leborgne-Samuel Y, Kadhel P, Ryan C, Vendittelli F. Sickle cell disease and pregnancy. La Revue du praticien. 2004;54:1578-82.
  11. Villers MS, Jamison MG, De Castro LM, James AH. Morbidity associated with sickle cell disease in pregnancy. Am J Obstet Gynecol. 2008;199(2):125.e1-5. [Crossref]  [PubMed] 
  12. Al Jama FE, Gasem T, Burshaid S, Rahman J, Al Suleiman SA, Rahman MS. Pregnancy outcome in patients with homozygous sickle cell disease in a university hospital, Eastern Saudi Arabia. Arch Gynecol Obstet. 2009;280(5):793-7. [Crossref]  [PubMed] 
  13. Royal College of Obstetricians & Gynaecologists. Sickle Cell Disease in Pregnancy, Management of (Green-top Guideline No. 61). 2011.
  14. Oteng-Ntim E, Pavord S, Howard R, Robinson S, Oakley L, Mackillop L, et al. British Society for Haematology Guideline. Management of sickle cell disease in pregnancy. A British Society for Haematology Guideline. Br J Haematol. 2021;194(6):980-95. [Crossref]  [PubMed] 
  15. Diallo D, Tchernia G. Sickle cell disease in Africa. Curr Opin Hematol. 2002;9(2):111-6. [Crossref]  [PubMed] 
  16. Sağlık Bakanlığı Riskli Gebelikler Yönetim Rehberi 2014.
  17. Asnani MR, McCaw-Binns AM, Reid ME. Excess risk of maternal death from sickle cell disease in Jamaica: 1998-2007. PLoS One. 2011;6(10):e26281. [Crossref]  [PubMed]  [PMC] 
  18. Keskin Kurt R, Güngören A, Hakverdi AU, Dolapçıoğlu KS, Benk Silfeler D, Karapinar O, Karateke A. Perinatal and Maternal Consequences of Pregnancies Complicated with Sickle Cell Anemia. The Journal of Gynecology - Obstetrics and Neonatology. 2014;11(2):33-6.
  19. Boulet SL, Okoroh EM, Azonobi I, Grant A, Craig Hooper W. Sickle cell disease in pregnancy: maternal complications in a Medicaid-enrolled population. Matern Child Health J. 2013;17(2):200-7. [Crossref]  [PubMed]  [PMC] 
  20. el-Shafei AM, Sandhu AK, Dhaliwal JK. Maternal mortality in Bahrain with special reference to sickle cell disease. Aust N Z J Obstet Gynaecol. 1988;28(1):41-4. [Crossref]  [PubMed] 
  21. Pintova S, Cohen HW, Billett HH. Sickle cell trait: is there an increased VTE risk in pregnancy and the postpartum? PLoS One. 2013;8(5):e64141. [Crossref]  [PubMed]  [PMC] 
  22. Koh MB, Lao ZT, Rhodes E. Managing haematological disorders during pregnancy. Best Pract Res Clin Obstet Gynaecol. 2013;27(6):855-65. [Crossref]  [PubMed] 
  23. Reducing the Risk of Thrombosis and Embolism during Pregnancy and the Puerperium (Green-top 37a). Royal college of medicine guideline 2009.
  24. Zia S, Rafique M. Comparison of pregnancy outcomes in women with sickle cell disease and trait. J Pak Med Assoc. 2013;63(6):743-6.