1. UHS CASE PRESENTATION
CASE : Sickle cell disease in
pregnancy at term with bad obstetric
history
PRESENTER: DR OJO B.G
MODERATED BY:DR BATURE S.B
24 August, 2023 1
2. BIODATA
• NAME :Mrs M M
• Age: 36yrs
• Occupation : House wife
• Marital status: Married
• Address :goni gora Kaduna
• Tribe…Gbagi
• Religion :christain
• Educational qualification : SSCE
• Date of admission :18/07/23
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5. HISTORY OF PRESENTING
COMPLAINTS
• Mrs M.M presented for her ANC and complain of lower abdominal
pain . Pains was mild ,not increasing in intensity or severity, non
radiating.
• There was no associated pain in other part of the body , no
associated fever, no history of dsyuria, no copious vaginal discharge
or itching
• She has not seen show, no drainage of liquor or vaginal bleeding
at presentation.
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6. HISTORY OF INDEX PREGNANCY
• Index pregnancy was desired and spontenously conceived.
• Booked her antenatal care in our facility at 21weeks of gestation.
• Booking parameters: genotype SS, Blood group 0+ and Stable PCV
is 22%. HbsAg ,HCV, RVS..negative
• She had one dose of tetanus toxoid and two doses of IPT (
intermittent preventive therapy)
• Had 2 hospital admission in this index pregnancy ( both in the 2nd
trimester).
• Last admission was 9/6/23 due to anaemia in pregnancy . PCV was
21%. She was transfused with 3 unit of blood (group compactible
genotype AA pack red cell).
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7. Past obstetric history
• G3P2+0 ( non Alive)
• LCB: 4yrs ago
• 1st pregnancy was 4 years ago and was booked in this facility
and it was complicated by anaemia and was transfused with 3
units.
• She carried it to term and had svd of fresh stillbirth after a
prolong labour.
• 2nd pregnancy was 3yrs ago and it was breech presentation
and was diagnosed in antenatal clinic ,
• she was scheduled for elective cs but went into labor at
37weeks +5/7 and had head entrapment with fresh stillborn in
this facility
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8. Past Gynecological History
• Menache was at 17yrs.
• She menstruate for 3days in a 28days cycle
• Has no history of use of any form of contraception.
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9. Past Medical History
• She is a known Sickle cell disease patient diagnosed at 5yrs of age ,
however commenced SCD clinic 4yrs ago.
• She has been compliant with her sickle cell clinic visit in this
hospital.
• She has been on folic acid and paludrine.
• She is not a known hypertensive or diabetic patient.
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10. Family and Social History
• She is married in a monogamous non consaguinous setting
• Husband is a 39yrs old welder whose blood group is B+, and
genotype is AA.
• No known family history of diabetes mellitus or hypertension
• She neither smoked cigarettes nor consumed alcohol.
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11. PHYSICAL EXAMINATION
• O/E A Young woman not in any painful afebrile not pale acyanosed
,not dehydrated no bilateral pitting pedal oedema
• Bp…110/70mmhg
• PR…86B/M.
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12. RESPIRATORY SYSTEM
• Respiratory rate was 20 cycles per minute.
• SPO2 92%
• Normal air entry with bilaterally symmetrical chest expansion and
trachea is centrally located
• Breath sounds are vesicular bilaterally no added sounds
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13. CARDIOVASCULAR SYSTEM
• Pulse rate was 96b/m, regular with good volume.
• Blood pressure was 110/70mmHg and Apex beat at the 5LICSMCL,
• S1 and s2 heart sounds and no murmur
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14. ABDOMINAL/ pelvic EXAMINATION
Abd: Gravidly enlarged abdomen, full moves with respiration ,no
area of tenderness and no palpable organomegaly
SFH:37cm,LL,Cephalic presentation
FHR; 142bpm.
pelvic: Normal vulvovaginal, Cervix is central, firm in consistency,
length 4cm uneffaced and closed
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16. Management
• Patient was admitted in maternity ward
• Investigation required : fbc + diff, mps, urinalysis, urine m/c/s,
• GXM , HBsag, HCV, RVS, EUCr
• Patient was counsel for elective cs for the next day however, to be
taken as emmergency cs if labour become established
• Consult was sent to haematologist for review
• encourage liberal fluid intake
• IV pcm 600mg stat then 300mg 8 hrly
• Patient to continue folic acid 5mg dyl and palludrine 100mg
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Any clarification on the
management plan
18. Haematology Unit Review
• Patient was reviewed by haematology unit
• Plan was to GXM genotype AA pack red cell and transfuse blood
loss during caesarean section ml per ml
• Supplemental oxygen
• Subcutaneous clexane 20mg dyl
• For further review
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19. Surgery
• Operation: ELLSCS
• Indication : Sickel cell diesease in pregnancy at term with bad
obstetric history
• Anaesthesia : GA
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20. Intraoperative findings
• Gravid uterus ,Well formed lower Uterine segment
• clean peritoneum
• Engorged vessels in the lower Uterine segment
• female neonate in Longitudinal lie cephalic presentation
Weighing 2.6kg
• Apgar score of 9 and 10 in 1st and 5th mins respectively
• Fundally located placenta
• Both tubes and ovaries grossly normal
• EBL:< 800mls
• Had one unit of blood transfused intra operatively
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21. POST OP MANAGEMENT
• NPO till review
• Indwelling catherter for 48hrs
• Post op PCV after 48hrs
• Monitor input and output
• Monitor vital sign…blood pressure and pulse rate and spo2
• Urinalysis
• Iv 5%D/W 1lit 8hrly x 48hrs add 20iu syntocinon in each lit x 24hrs
• Subcut clexane 40mg dly x 5/7 after 12hrs of surgery
• Iv amoxiclav 1.2g 12hrly x 48hrs then tabs 625mg bd x 1/52
• Iv metronidazole 500mg 8hrly x 48hrs then tabs 400mg tds x 1/52
• Iv pentazoncine 30mg 6hrly x 48hrs
• Im diclofenac 75mg 12hrly x 48hrs
• TOP UP transfusion with Group compatible Genotype AA blood, 1 .0
unit
• Supplemental INO2 via face mask
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ANY queries or question on
the post - op management
22. Discharge
• Before patient was discharged
• Baby was immunized
• Ptx was counseled on contraceptive
• Ptx was counseled on exclusive breast feeding
• Ptx was informed to complete oral medications
• Ptx was discharged 5 days post operative to be
reviewed in post natal clinic in two weeks
• For hematologist review in clinic
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23. Post natal clinic
• First post natal clinic visit
• Ptx was reviewed by the nurses on morning shift in ANC
as there was an industrial strike embarked on by the
doctors
• Mother and baby were said to have been doing very fine.
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24. Discussion points
• Please kindly share your experience in managing sickle cell disease
in pregnancy in your centre if there is any, both antenatally,
intrapartum and post partum.
• what is the role of preconception care for a SCDX ptx in your setting.
• Do you offer prenatal diagnosis of fetus for sickle cell mother on baby
at risk.
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