Estudo das complicações e fatores determinantes de óbito materno e near miss em gestantes com doneça falciforme

Abstract

INTRODUCTION Sickle cell disease during pregnancy is associated with increased complications due to the disease itself and with a higher maternal and perinatal mortality. The aim of the study was to analyze the clinical complications of pregnant women with sickle cell disease, with primary focus on those potentially serious and life-threatening (near miss) or leading to actual maternal death. We sought to identify predictors of near miss or maternal death in order to provide information to reduce complications and improve maternal or perinatal prognosis.METHODS The 104 patients were enrolled in the Blood Center of Belo Horizonte (Hemominas Foundation) and were treated at several institutions that provide high-risk prenatal care. The study was a prospective cohort. As for the genotypes of sickle cell disease, patients were divided into two groups: Group I (n=54), consisting of sickle cell anemia (HbSS, n=51) or S 0 -talassemia (n=3) and Group II (n=50), SC hemoglobinopathy (n=49) or S +-talassemia(n=1). The median age of both groups was 25 and 26 years, respectively. Predictive factors for near miss or maternal death with alpha error probability p 0,25 in univariate analysis were included in a multivariate logistic regression model and then those with p0,05 were considered significant. RESULTS Women in Group I showed, compared to Group II, higher number of episodes of vaso-occlusive crises during pregnancy, higher number of blood transfusions in both antepartum and postpartum and a higher percentage of preterm births. The frequency of infections and pain crises during the postpartum period was similar in both groups. Urinary infect ions were equally common in both groups. The overall mortality rate was 4,8%, three deaths in the sickle cell anemia group and two in the SC group. One third of the women in each group had severecomplications classified as indicative of near miss. The most frequent complication was pneumonia/acute chest syndrome. The co-inheritance of alpha thalassemia and beta globin gene haplotypes (CAR/CAR, Benin/Benin or CAR/Benin) were not significantly associated with near miss or maternal death. Significant predictive factors for near miss or maternal death in both groups together were: mother with parity > 1 and basal red cell macrocytosis. In Group I, baseline hypoxemia (oxygen saturation below 94%) was also predictive of near miss or maternal death. CONCLUSIONS - Pregnant women with sickle cell disease had several complications during pregnancy and postpartum. One third of the women suffered near miss and almost 5% died. SS and SC pregnant women had the same risk of severe complications and maternal deaths, especially in the third trimester and postpartum period. Pulmonary events were the most frequent complications and deserve special care, including performing partial exchange blood transfusion. Specialized training in high- risk prenatal care for several complications o f sickle cell disease and early identification of risk factors for near miss or maternal death are fundamental to improving care for pregnant women with sickle cell disease.