Clinical 'pearls' of maternal critical care Part 2: sickle-cell disease in pregnancy.
OBJECTIVE
The current review outlines the challenges in managing pregnant women with sickle-cell anemia, who are at risk of becoming critically ill during pregnancy.


RESULTS
Sickle obstetric patients pose unique challenges to the anesthetist and intensivist. We discuss the role of prophylactic transfusions for specific indications like acute anemia and twin pregnancies. The management and prevention of vaso-occlusive crises and chest crisis are also outlined. The role of the multidisciplinary team cannot be overstated.Massive obstetric hemorrhage in this population is difficult, and unique considerations such as cell-saver technology and tranexamic acid usage are discussed. Secondary complications such as pulmonary hypertension and stroke are also considered, with a summary of the latest treatment guidelines.


CONCLUSIONS
This is a challenging cohort of pregnant patients who have a significantly increased morbidity and mortality. This review aims to aid management of these patients on the labor ward for both obstetric anesthetists and intensivists.
aDepartment of Anesthesiology, Queen's Hospital, BHR University Hospital NHS Trust, Romford bQueen Mary University of London, London cDepartment of Anesthesiology, Princess Royal Hospital, King's College Hospital NHS Trust, Farnborough dDepartment of Obstetrics and Gynecology, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, UK.
Vinod
V
Patil
Gamunu
G
Ratnayake
Galina
G
Fastovets
D056586:Acute Chest Syndrome / Q000175:diagnosis / Q000628:therapy; D000755:Anemia, Sickle Cell / Q000628:therapy*; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001803:Blood Transfusion / Q000592:standards / Q000639:trends; D003422:Critical Care / Q000379:methods*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000175:diagnosis / Q000628:therapy; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000628:therapy; D015994:Incidence; D033183:Interdisciplinary Communication; D007743:Labor, Obstetric; D057725:Operative Blood Salvage; D010348:Patient Care Team; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000628:therapy*; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000628:therapy; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D014148:Tranexamic Acid / Q000627:therapeutic use
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid