[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

[Abdominal pain in case of uni-cornuate uterus]

Thinking of the diagnosis of complicated uterine malformation in case of acute abdominal pain. In our case, the patient was holding a unicornuate uterus and was admitted for abdominal pain. The etiological diagnosis was performed during laparotomy leading to hemi-hysterectomy. The unicornuate uterus with rudimentary horn results of a failure of the mullerian ducts. This malformation is discovered during examinations for infertility or after acute complication. The diagnosis is established by imaging [ultrasonography and magnetic resonance imaging] and laparoscopy. Although rare, these malformations should be evocated when patient present abdominal pain and justify the surgical excision of the rudimentary horn to prevent complications [endometriosis, sever dysmenorrhea, rupture of ectopic pregnancy in a rudimentary uterine horn]