Maintenance for Women with Sickle Cell Disease
Pregnancy carries some increased risk for a woman with sickle cell disease and her fetus, but risks are not so great as to prohibit desired pregnancies. Every sexually active woman, affected with sickle cell disease, should be advised of the likelihood that her pregnancies will be successful but should also be advised that some risks may be greater than for women without sickle cell disease. Particular attention should be given to ensure the genetics of sickle cell disease is understood.
Contraception
Sickle cell disease is not an indication for sterilization. Contraception, however, offers the option of informed family planning. This should be discussed with the gynecologist. Adolescents and preteens should receive sex education that includes a discussion of abstinence. Low estrogen contraceptives are preferred.
Management of Pregnancy
Early medical care is imperative with the first sign of a pregnancy. It is advisable that care during pregnancy should be obtained by obstetricians who are experts in the care of the pregnant woman with sickle cell disease. All routine prenatal screening examinations should be performed with added assessment of the vital organs and life style. There should be screening for the presence of red cell alloantibodies, regardless of the history of transfusions. The father should also have his hemoglobin type identified. Genetics should be completely explained to both parents-to-be. Some physicians may institute prophylactic transfusions in asymptomatic pregnant patients with SS disease. Transfusions, however, play an important role in the management of acute events.
Sickle Cell Related Complications of Pregnancy
The management of painful episodes does not necessarily differ during pregnancy (see item entitled complications or pain). Medications for pain should be monitored closely by doctors. Hydration is important. Complications that can occur include acute chest syndrome, right upper quadrant syndrome, acute anemia, onset of new neurological events, and septicemia (blood infection). These are usually managed as in non-pregnant individuals. Preexisting complications may worsen during pregnancy.