RESUMO
Pregnancy in women with sickle cell disease (SCD) is associated with increased maternal and fetal morbidity and mortality. Outcomes vary widely owing to methodological limitations of clinical studies, but overall, hypertensive disorders of pregnancy, venothromboembolism, poor fetal growth, and maternal and perinatal mortality are increased globally. Few therapeutic interventions have been explored other than prophylactic and selective transfusion therapy. Unfortunately, existing data are limited, and it remains unclear whether prophylactic use of chronic transfusions will improve pregnancy outcomes. Management of pregnant women with SCD is best accomplished with a multidisciplinary team that includes a sickle cell expert and an obstetrician familiar with high-risk pregnancies. Women with SCD should have individualized care plans that outline management of acute pain and guidelines for transfusion therapy. Neonates require close monitoring for neonatal abstinence syndrome and hemolytic disease of the newborn. Ideally all young women with SCD will have a "reproductive life plan" developed as a component of preconception counseling and health promotion. Research leading to improved pregnancy management focused on diminishing adverse maternal and neonatal outcomes is overdue. International collaborations should be considered to improve subject recruitment and foster timely completion of clinical trials. Additional therapeutic interventions outside of transfusion therapy should be explored.
Assuntos
Anemia Falciforme , Transfusão de Sangue , Eritroblastose Fetal , Retardo do Crescimento Fetal , Síndrome de Abstinência Neonatal , Complicações Hematológicas na Gravidez , Tromboembolia Venosa , Adulto , Anemia Falciforme/metabolismo , Anemia Falciforme/patologia , Anemia Falciforme/terapia , Eritroblastose Fetal/metabolismo , Eritroblastose Fetal/patologia , Eritroblastose Fetal/prevenção & controle , Feminino , Retardo do Crescimento Fetal/metabolismo , Retardo do Crescimento Fetal/terapia , Humanos , Síndrome de Abstinência Neonatal/metabolismo , Síndrome de Abstinência Neonatal/patologia , Síndrome de Abstinência Neonatal/prevenção & controle , Gravidez , Complicações Hematológicas na Gravidez/metabolismo , Complicações Hematológicas na Gravidez/patologia , Complicações Hematológicas na Gravidez/terapia , Tromboembolia Venosa/metabolismo , Tromboembolia Venosa/patologia , Tromboembolia Venosa/terapiaRESUMO
Pregnancy in sickle cell disease (SCD) has been associated with increased complications such as vaso-occlusive crises, severe anemia and foetal loss. It has been proposed that the sickling of red blood cells (RBCs) inside the placenta circulation could participate to these complications. The present study investigated the adhesion of sickle RBCs on human trophoblast-derived cell and its extracellular matrix. Results demonstrated 1) similar adhesion of sickle RBCs and healthy RBCs to trophoblast but 2) a greater adhesion of sickle RBCs to the extracellular matrix of trophoblasts as compared with healthy RBCs. This greater adhesion could partly involve the Lu/BCAM glycoproteins and could participate to the complications reported in SCD pregnant women.
Assuntos
Anemia Falciforme/complicações , Eritrócitos/patologia , Placenta/irrigação sanguínea , Complicações Hematológicas na Gravidez/sangue , Trofoblastos/citologia , Adulto , Adesão Celular , Linhagem Celular , Deformação Eritrocítica , Matriz Extracelular/metabolismo , Feminino , Humanos , Gravidez , Complicações Hematológicas na Gravidez/metabolismo , Complicações Hematológicas na Gravidez/patologiaRESUMO
OBJECTIVE: To determine placenta alterations in iron deficiency anemia cases and the effect of this condition on birthweight. PATIENTS, MATERIAL AND METHODS: One hundred and fifty three women with term-pregnancy and their newborns were included. Patients with iron deficiency anemia were those with an hemoglobin of less than 11.0 g/dL and serum ferritin below 12 micrograms/L. Outcome variables were: placenta weight, placenta weight/newborn weight ratio, macroscopic and microscopic alterations on placenta, weight and height of the newborn. RESULTS: The frequency of iron deficiency anemia was determined in 26 patients, 17%. The placenta weight in the group of women with a diagnosis of iron deficiency anemia was 558 +/- 105 g and in the group of women without this diagnosis 527 +/- 107 g (p = 0.18). Placenta weight/newborn weight ratio was higher in the anemia group patients (p = 0.04). The most frequent microscopic lesions observed were intervillous thrombosis, infarcts and fibrosis. The birthweight and length of newborn was similar in both groups. CONCLUSION: A trend towards an increase in placenta weight and in the placenta weight/newborn weight ratio in patients fulfilling the anemia criteria was observed, but a significant effect on the weight and height of the newborn was not determined, suggesting that the changes present in the placenta would be enough to ensure a fetal growth.
Assuntos
Anemia Ferropriva , Peso ao Nascer , Placenta/patologia , Complicações Hematológicas na Gravidez , Adulto , Anemia Ferropriva/patologia , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Gravidez , Complicações Hematológicas na Gravidez/patologia , Resultado da GravidezRESUMO
Pathological changes often occur in the placenta of women with sickle cell disease (SCD). These alterations are caused by sickling of erythrocytes and vasoocclusion in the placental circulation, leading to regional hypoxia. However, the morphological status of the umbilical cord, which is in close physical association with the placenta, is not documented under such conditions. To explore this, the umbilical vein structure in healthy, sickle cell trait (the heterozygous state), and SCD pregnancies was studied using scanning (SEM) and transmission electron microscopy (TEM). Interestingly, the sickle cell trait umbilical vein architecture was morphologically similar to that in control veins, whereas numerous alterations were seen in the SCD umbilical vein wall. In SEM, the SCD umbilical vein endothelial cells showed atypical morphologies. TEM analysis of the tunica media showed (1) smooth muscle cell proliferation and increase in the thickness of the basement membrane underlying the cells; (2) areas of necrosis; (3) reduplication of the inner elastic lamina. Such features were often seen in sickle patients vasculature at autopsy. Our findings could have importance because tissue hypoxemia is an integral part of vasoocclusion. We conclude that the SCD umbilical vein may be an additional tool for studying vasoocclusion in sickle cell disease.