Pregnancy outcome of sickle cell disease women

Objective: To evaluate the maternal and fetal outcome in pregnant women with sickle cell disease [SCD] compared with healthy women

Setting: Department of Gynecology and Obstetrics, Salmaniya Medical Complex, Bahrain

Design: Retrospective Case-Control Study

Method: Patients with SCD who delivered from 1 January 2011 to 31 December 2012 were reviewed. The matched controls had neither SCD nor sickle cell trait

Result: Patients with sickle cell disease required significantly more admissions during their pregnancy, 135 [78.4%] compared to the control, 74 [37.4%]. One hundred thirteen [65.6%] SCD patients were admitted with vaso-occlusive crises and 18 [10.4%] with hemolytic crises. SCD patients had a significant decrease in parity, gestational age and birth weight compared with the control group. SCD patients had a significant rise in the incidence of urinary tract infection, but there was no difference between both groups in the incidence of hypertensive disorders, mode of delivery and perinatal outcome. Four [2.3%] patients with SCD died; two [1.2%] patients died due to pulmonary embolism, one [0.6%] due to acute chest syndrome and one due sepsis and disseminated intravascular coagulopathy

Conclusion: Sickle cell disease is hazardous both to the mother and the fetus and is associated with high maternal morbidity and mortality

Prevalence and risk factors for vitamin D deficiency among mothers in labor and their newborns

Vitamin D deficiency is recognized as a global public health problem. Studies of vitamin D levels in mothers in labor and their newborns in Bahrain are lacking. The aim of this study is to identify the prevalence of vitamin D [25[OH]D] deficiency among mothers in labor and their newborns in Bahrain. A cross-sectional multicenter study. Four Public and Four Private Maternity Hospitals in Bahrain. The study was conducted in April 2012. It included mothers in labor and their newborns. Differences between the subgroups were analyzed using Chi-Square or Student's t-test as appropriate. Linear regression analysis was used to evaluate independent predictors of 25[OH]D level. The study included 403 mothers and 403 newborns. Overall prevalence of 25[OH]D deficiency [<50 nmol] was 358 [88.8%] of the mothers and 364 [90.3%] of the newborns. The mean maternal alkaline phosphatase level was significantly higher than the neonatal level and the maternal mean calcium was significantly lower than the neonatal level. Significant association with vitamin D deficiency was found among Bahraini and non-Bahraini Arab mothers, delivering in public rather than private hospital, living in flats, low education, the use of veil, gravida >/= 4, not using multivitamins, vitamin D or calcium supplements. Vitamin D deficiency among mothers and their newborns is high. This mandates increasing awareness, vitamin D supplementation among mothers in labor and their infants; in addition to the introduction of vitamin D fortification of dairy products and flour at the national level

Management of primitive neuro-ectodermal tumor of the vagina in a sickle cell disease patient

A twenty-five years old female, a known case of sickle cell disease, presented with frequent and heavy periods of six months duration. Pelvic ultrasound and MRI showed a vaginal mass pushing the bladder anteriorly; the diagnosis of cervical fibroid was considered. Histopatholgical examination of the mass revealed a very rare entity of primitive neuro-ectodermal tumor of the vagina. This is the first recorded patient of sickle cell disease with primitive neuro-ectodermal tumor of the vagina. The management was challenging in dealing with her disease and preserving her fertility

Dicephalus dibrachius with anencephaly

We present a case of inferior conjunction in a rare type of conjoined twins, dicephalus in a male fetus. The male fetus was born to a 24-year-old, gravida 2, and para 0, who had medical abortion at 15 weeks of gestation due to anencephaly with meningoencephalocele revealed by ultrasound examination. The fetus was born with 2 anencephalic heads with a bifurcation of the vertebral column and presence of 2 spinal cords. The other viscera and limbs were normal in number and location as for a male singleton. This case illustrates the relationship between conjoined twining, and neural tube defect more particularly anencephaly with a male zygote, which is an unusual presentation for this type of zygote gender