The rate of sickle cell disease (SCD) is on the increase in Europe and the US and is the world’s most common inherited condition. In the UK there are approximately 12-15,000 individuals affected and it is associated with maternal and fetal complications.
New guidelines on the management of SCD in pregnancy are published today by the Royal College of Obstetricians and Gynaecologists (RCOG) and recommend that each hospital should have a protocol for the management of pregnant women with the condition and that a multidisciplinary team consisting of an obstetrician, a midwife and a haematologist should be available.
SCD is most prevalent in individuals of African descent as well as Caribbean, Middle East, India, Mediterranean and South and Central America. However due to migration there are increasing numbers in other parts of the world.
The disease affects the shape of the red blood cells and they are formed in a rigid sickle shape.
SCD is associated with an increased risk of perinatal mortality, premature labour, fetal growth restriction and acute painful crises during pregnancy.
The new Green-top guidelines also recommend:
- Women with SCD should be seen preconceptually by a sickle specialist to find out about how the disease affects pregnancy
- Individuals should be encouraged to be screened and at risk couples should have access to counselling and advice on reproductive options
- Folic acid as well as penicillin prophylaxis should be given daily both before conception and during pregnancy
- Pregnant women should be offered fetal growth scans every four weeks from 24 weeks of gestation
- Women need to be rapidly assessed when painful crises occur and the appropriate management including analgesia administered
- Women with the condition should be advised to give birth in hospital
- Continuous intrapartum electronic fetal heart rate monitoring is recommended as there is an increased risk of fetal distress which may result in operative delivery
- As complications for mother and baby could be unpredictable, delivery should be considered between 38 to 40 weeks of gestation
Dr Eugene Oteng-Ntim, Consultant Obstetrician, Guy’s and St Thomas’ NHS Foundation Trust and co-author of the guidelines said:
“These new guidelines cover preconceptual screening for sickle cell disease, antenatal, intrapartum and postnatal management.
“We are seeing more of the condition and there are approximately 100–200 pregnancies in women with sickle cell disease every year, with a mortality of two to four each triennium in the UK.
“It is essential that all staff in maternity care should receive training in the care of this high risk group of women to ensure the best outcome for both mother and baby.”
For more information please contact Naomi Weston on 020 7772 6357 or firstname.lastname@example.org
These guidelines were produced on behalf of the RCOG by Dr Eugene Oteng-Ntim, Consultant Obstetrician and Dr J Howard , Consultant Haematologist, Guy’s and St Thomas’ NHS Foundation Trust, London.
To read the full guideline please click here.