Acute pain episodes, acute chest syndrome, and pulmonary thromboembolism in pregnancy

Abstract

Pregnancy in women with sickle cell disease (SCD) is a life - threatening condition. In both high - and low - income countries, there is an 11 - fold increased risk of maternal death and a 4 - fold increased risk of perinatal death. We high light the epidemiology of SCD - specific and obstetric com plications commonly seen during pregnancy in SCD and pro pose definitions for acute pain and acute chest syn drome (ACS) episodes during pregnancy. We conducted a systematic review of the recent obstetric and hematology literature using full research articles published within the last 5 years that reported out comes in pregnant women with SCD. The prevalence of acute pain episodes during pregnancy ranged between 4 % and 75 %. The prevalence of ACS episodes during pregnancy ranged between 4 % and 13 %. The estimated prevalence of pulmonary thromboembolism in women with SCD during pregnancy is approximately 0.5 to 1 %. ACS is the most common cause of death and is often preceded by acute pain episodes. The most crucial time to develop these complications in pregnancy is during the third trimester and post par tum period. In a pooled anal y sis from studies in low - and middle - income set tings, maternal death in women with SCD is approximately 2393 and 4300 deaths per 100 000 live births with and without multi-disciplinary care, respectively. In com par i son, in the US and north ern Europe, the general maternal mortality rate is approximately 23.8 and 8 deaths per 100 000 live births, respectively. A multi-disciplinary SCD obstetrics care approach reduces maternal and perinatal morbidity and mortality in low - and middle - income countries