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Sickle-cell crisis in pregnancy near term

Report of a case
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      Abstract

      A case of sickle-cell crisis occurring near term pregnancy has been presented. This case was further complicated by the development of severe preeclampsia which has been shown in the literature to be more prone to develop in the patient with sickle-cell disease.
      The main problem presented is that of replacing hemoglobin to a blood volume greater than would be found in the nonpregnant state. The fluid retention of toxemia added to the difficulty of this problem. For these reasons the patient was treated rigorously to accomplish diuresis while hemoglobin was being replaced very slowly with packed erythrocytes. The object of treatment was to raise the hemoglobin level to a point safe for delivery without overloading the cardiovascular system or precipitating further difficulties with the sickle-cell disease.
      The heart murmurs heard in this case are difficult to explain on other than a rheumatic or congenital basis. It is a fact that the patient with sickle-cell disease in crisis may have joint swelling, low-grade fever, and heart murmurs indistinguishable from those of rheumatic fever; however, the persistence of these murmurs between episodes of crisis would not be likely to occur. Burke and Rosenfeld3 reported a similar case in 1953 in which the diagnosis of rheumatic heart disease had been made prior to the time sickle-cell disease was proved. In this case, however, the murmurs did not persist between episodes of crisis, and it was justly assumed that the original diagnosis was in error.
      The over-all plan of therapy in this case follows that suggested in the literature. This includes replacement of blood, use of antibiotics to prevent infection, reduction of the amount of trauma associated with actual delivery, and rigorous treatment of complicating factors such as toxemia. Caruso suggested that since the sickle cell is a poor oxygen carrier, continuous oxygen therapy may be advisable during labor.
      Postpartum care was directed toward replacement of blood lost during delivery, continuation of antibiotic therapy, and general supportive care.
      From this case presentation it can be seen that close supervision of the prenatal course of all pregnant Negro patients with early efforts to diagnose the presence of sickle-cell disease will facilitate early treatment and safe delivery.
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      References

        • Anderson G.W.
        • Busby T.
        Am. J. Obst. & Gynec. 1949; 58: 75
        • Beecham W.D.
        • Beecham D.W.
        Obst. & Gynec. Surv. 1951; 6: 455
        • Burke L.
        • Rosenfeld H.
        Am. J. Obst. & Gynec. 1953; 65: 670
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        Am. J. Obst. & Gynec. 1953; 66: 637
        • Fouché H.H.
        • Switzer P.K.
        Am. J. Obst. & Gynec. 1949; 58: 468