Sickle cell crisis in pregnancy - query bank

Question: How to manage sickle cell crises in pregnancy?

This clinical query answer was produced by RCOG Library staff following the clinical query protocol as described here.

Answer:

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A Cochrane review of interventions for treating painful sickle cell crisis during pregnancy (Martí-Carvajal) did not find any randomised clinical trials on interventions (packed red cell transfusion, oxygen therapy, fluid replacement therapy, analgesic drugs, and steroids) for the treatment of painful sickle cell crisis during pregnancy.

The following guidelines were identified:

  • RCOG. Management of Sickle Cell Disease in Pregnancy. 2011.
    5.7 What is the optimal management of acute painful crisis during pregnancy?
    Women with SCD who become unwell should have sickle cell crisis excluded as a matter of urgency.
    Pregnant women presenting with acute painful crisis should be rapidly assessed by the multidisciplinary team and appropriate analgesia should be administered. Pethidine should not be used because of the associated risk of seizures.
    Women admitted with sickle cell crisis should be looked after by the multidisciplinary team, involving obstetricians, midwives, haematologists and anaesthetists.
    The requirement for fluids and oxygen should be assessed, and fluids and oxygen administered if required.
    Thromboprophylaxis should be given to women admitted to hospital with acute painful crisis.
  • American College of Obstetricians and Gynecologists. Hemoglobinopathies in pregnancy. 2007
    This includes one paragraph on the management of painful sickle cell crises in pregnancy.
  • British Committee for Standards in Haematology. Guidelines for the Management of the Acute Painful Crisis In Sickle Cell Disease. 2003
    This guideline is currently being updated but it remains as current guidance until the update is completed.
  • Sickle cell Society. Standards for the Clinical Care of Adults with Sickle Cell Disease in the UK. 2008
    Some women may experience more painful crises during pregnancy. If the crisis is severe admit the patient to hospital under joint care of an obstetrician and haematologist. The local policy should indicate choice of ward (i.e. haematology or antenatal) and pain should be managed as normal according to the local pain policy (see also BCSH guideline) with the following cautions:
    • NSAIDs (e.g. diclofenac) should be used with caution in pregnancy and should not be given in early pregnancy (first trimester) or after 32 weeks gestation (due to the risk of premature closure of the ductus arteriosus)
    • Fetal well-being should be assessed regularly with sonicaid/cardiotocography as appropriate

(Evidence level IV)

References:

Search date: February 2012

Classification of evidence levels

Ia Evidence obtained from meta-analysis of randomised controlled trials.

Ib Evidence obtained from at least one randomised controlled trial.

IIa Evidence obtained from at least one well-designed controlled study without randomisation.

IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.

III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.

IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.

 

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Date published: 10/02/2012

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