ABSTRACT
This chapter opens with the natural history of sickle cell disorder in low- and middle-income countries (LMICs) listing the most common complications in pregnancy. It goes on to describe the ideal pre-conceptual care regimes with emphasis on the LMIC context and what is feasible therein, and how to carry out routine antenatal care for women with the disorder.
The general and specific management regimens of the various complications that occur during pregnancy, are described with special attention to vaso-occlusive crises, pneumonia, and the acute chest syndrome. Controversies surrounding the use of hydroxyurea, vaccines, iron therapy, prophylactic antibiotic therapy, and blood transfusion are discussed. The unique second patient in pregnancy, i.e. the fetus, and the effects arising from the effects of sickle cell disease on the fetus, namely intrauterine growth restriction and low birth weight, which lead to increased perinatal mortality, are emphasised. Methods of monitoring the fetus in order to reduce perinatal death and how to avoid morbidity are also mentioned.
The chapter ends with the recommended mode and conduct of delivery for pregnant women with sickle cell disorder,, and methods of induction of labour. Contraceptive use and advantages of the different types of contraception are highlighted.
