Pharmacology of Obstetrics
Pregnancy in SCD is high-risk. Vaso-occlusive crises, infections, and preeclampsia threaten mother and fetus. Multidisciplinary care is essential.
Pathophysiology
HbS → sickling under hypoxia → vaso-occlusion, hemolysis, ischemia.
Pregnancy ↑ blood volume, CO, hypercoagulability → exacerbates crises.
Maternal Risks
- Vaso-occlusive crises (most common)
- Acute chest syndrome
- Infections (UTI, pneumonia)
- Anemia, preeclampsia, thromboembolism
Any acute deterioration → rule out crisis, infection, ACS
Fetal Risks
- IUGR, preterm birth, stillbirth
- Neonatal complications from prematurity
Antenatal Management
Preconception
- Genetic counseling
- Folic acid 5 mg/day
- Vaccinations
Antenatal
- Multidisciplinary team
- Transfusions if severe/recurrent crises
- Hydration, avoid triggers
Intrapartum & Postpartum
- Vaginal preferred
- Epidural, O₂, IV fluids
- Postpartum: pain control, thromboprophylaxis
- Crises peak in first 72h
Key Takeaways
- SCD + pregnancy = high-risk
- Crises ↑ in pregnancy
- Folic acid 5 mg/day
- Serial growth scans
- Avoid hypoxia, dehydration
- Multidisciplinary care
Conclusion
SCD in pregnancy requires vigilance, hydration, and teamwork. Early intervention saves lives.
SCD in pregnancy is a tightrope — balance is key.