[Sickle cell disease and pregnancy]

Patients with sickle cell disease have abnormal red blood cells. This can cause chronic hemolytic anemia and vaso-occlusion leading to tissue hypoxia and organs dysfunction. Pregnancy in this category of patients is rare with a 1% rate. It has been associated with increased obstetric risks and sickle cell crises. A 30-years-old patient is carrier of major sickle cell disease. In her obstetric history we report two late abortions. The current pregnancy in complicated by hemolyse crisis and foetal hypotrophy. Evolution is marked by in utero foetal death in the 30 weeks of amenorrhoea. Association of sickle cell disease and pregnancy is a purveyor of morbidity and an important foetal [30%] and maternal [la 2%] mortality. These patients often present with multiple visceral lesions, so the pregnancy can be authorized only after a normal pre-conceptionnal check up of their disease. Sickle cell crisis is favoured by pregnancy and complicates it with increase rate of prematurity [35 in 45%]. The disturbance of the materno-foetaux exchanges is responsible of in utero foetal deaths, fetal growth retardationa preeclampsia, placental abruption and miscarriages. The treatment of crisis remains symptomatic. It seems now accepted that systematic transfusion from 26 weeks of amenorrhoea, to obtain a rate of HbS <40% reduces complications and urgency transfusions. The sickle cell disease is a serious illness. Pregnancy of sickle cell patients is possible but must be planned. Management of this Pathology requires collaboration between internist, obstetrician and reanimator

[Delivery of macrosomic]

Management of fetal macrosomia is a situation that obstetricians are often faced. Independently of its etiology, the macrosomian exposed to major complications, dominated during delivery by the risk of shoulder dystocia, which is rare but dramatic situation, requiring the presence of a trained obstetrician ready to cope. We describe results of a retrospective study of 438 cases of confinement of newborn weighing 4000g or more, in our department trough one year period, from 1 January till 31 December 2007. Frequency was of 6.5%, maternal age >30 years old in 59% of cases, mothers average weight was over 80 kg in 56%. A family history of diabetes was found in 18.7%, primiparous was 31% while multiparity was 35%. The diagnosis of macrosomia has been suspected and identified only prior to work in 15.75%. Caesarean section was licited in 30% cases. The complications following vaginal delivery were shoulder dystocia in 22 cases. The neonatal complications were noted in 44 cases, they were represented by: hypoglycemia at birth [7%], 6 cases of acute foetal and one case of neonatal Jaundice. 17 cases were transferred to different pediatrics departments. The main observed maternal complications were represented by: 6 cases of postpartum hemorrhage, cervical tears in 12 cases, 21 vaginal tears and 16 cases of perineal tears, no case of uterine rupture or maternal death has been reported. By an appropriate management during macrosomic vaginal delivery, close monitoring and directed the work with a good command of obstetric maneuvers, we can reduce the risky associated with this delivery and woke it as a mangeable delivery of a non-macrosomic newborn