Gynecology and Obstetrics Department, Adnan Menderes University, Aydın Evaluation of two cases of sickle cell anemia and thalassaemia in pregnancy Selda Demircan Sezer Gynecology and Obstetrics Department, Adnan Menderes University, Aydın

Case 1: G2P1, 33-year-old, 7 wks' gestation Heterozygote for beta-thalassemia + hemoglobin S History: ES / 15 days interval until delivery Vaso-occlusive crisis in present pregnancy Exchange transfüsion (5 times) and 2-3 U ES given/1 month interval until delivery Hb (hemoglobin): 6,8-8,7 g/dL

Case 1: Caesarean section (CS) because of previos CS history Exchange transfusion made before CS 3440gr baby, 1st Apgar score 9, 5th Apgar score 10, male fetus delivered Postpartum 2 U ES No complication

Case 2: G2P1,37-year-old, 17 wks' gestation Double heterozygote for beta-thalassemia and hemoglobin S Obstetric History: No Exchange transfüsion and intrauterin fetal death at term, DIC No vaso-occlusive in present pregnancy Exchange transfüsion 7 times and 2-3 U ES /1 month interval until delivery

Case 2: Hb: 6,2-8,4 g/dL At 38th wk planned CS made becaause of previos intrauterin death 2 U exchange transfusion preoperative 3120gr, 1st Apgar score 6, 5th Apgar score 7, male fetus Intrapartum 1 U ES No complication

Pregnancy increases the incidence of sickle cell specific complications: Anaemia Vaso-occlusive crisis, abdominal, pulmonary (acute chest syndrome) Placental thrombosis Infections (urinary tract infection, pyelonephritis, pneumonia) Toxemia

Pregnancy increases the incidence of sickle cell specific complications: Maternal death High risk of spontaneous abortion Intra-uterine growth retardation Intra-uterine fetal death Preterm delivery Perinatal mortality related to hypoxemia and placental thrombosis

Evaluation of sickle cell anemia Specific management program A close multidisciplinary approach for the duration of the pregnancy, the delivery and the postpartal period In tertiary maternal health services level Blood transfusion depends on teams Restricted maternal, obstetrical and hematologic indications

Summary Fetal mortality and morbidity high Intrauterine growth retardation Fetal death being the most frequent fetal complications The rates of prematurity and caesarean section A multidisciplinary and specific approach Manage efficiently pregnancy, delivery and postpartum