SICKLE CELL ANAEMIA AND PREGNANCY
SISTER FULAANAH: Assalaam alaykum doc.
DR FULEEN: Waalykum salaam my dear. How are you doing today?
S. FULAANAH: Fine ma… Erm… Doctor, I’m getting married in April. And I’ve been so worried about my status as “SS”. Marital life, pregnancy, childbirth and all… I need your professional advice please.
DR FULEEN: Oh! That’s good news. First of all, congratulations in advance. I wish you a blissful marriage.
S. FULAANAH: Aameen. Thanks doc.
DR FULEEN: I want to assure you that you don’t have anything much to worry about. You’re just like any other person getting married. You have the right to enjoy your marriage to the fullest. I hope you know your fiance’s genotype too?
S. FULAANAH: Yes doc. He is AA.
DR. FULEEN: Perfect! I’m sure you know better. All of your children will be AS and that’s fine. You don’t want to imagine your children going through the same stress you have been through all these years…
I assume you’ve been taking your folic acid regularly, but now is the time to be even more religious about it. You need it for yourself as well as for your baby. You know, because the turnover of your red blood cells is very high, you will need more folic acid than other people, and even more in pregnancy. So, the ideal time to start is 3 months before your wedding day.
S. FULAANAH: OK doc. Though I have not been taking it consistently in the past few weeks… I’ll have to be more consistent now.
DR FULEEN: That’s better. In fact, you should be taking 5mg instead of the 1mg we usually give you before.
S. FULAANAH: What about ferrous? I heard that pregnant women need to take iron, will I need to take more iron too?
DR FULEEN: No. In your case, iron is not necessary because you already have enough stores from frequent breakdown of your red blood cells. We don’t want to tilt you into iron overload. If, at any point, your blood level goes down, we may need to transfuse you with blood, rather than giving you iron tablets.
And… Erm… Going through your file, you’re not on any other medication, like iron-chelators. Otherwise, I would have told you to stop before getting pregnant since they could be harmful to the unborn baby.
S. FULAANAH: No doctor. I’m not taking anything else.
DR FULEEN: Good. Good. Now, let’s talk about pregnancy. As soon as you conceive, I will refer you to the Obstetrics and Gynaecology Department. We as haematologist will collaborate with them to ensure a safe and healthy pregnancy. They will surely give you special attention as an “high risk” pregnancy.
S. FULAANAH: SubhaanaLlaah! What kind of risks are we talking about?
DR. FULEEN: Calm down sis. It’s not that bad. We only need to ensure that you keep away from anything that could trigger a crisis, as for any other SS individual – dehydration, cold, stress, low oxygen, infections (like malaria) and physical exertion. Although, there’s a slightly higher risk of Pre-eclampsia, miscarriage, preterm labour and fetal distress. Our team will ensure that you get the best standard of care and support. We only need your cooperation and compliance.
S. FULAANAH: Sure doctor. I trust you and the rest of the team… What about delivery doctor? Should I go directly for CS?
DR. FULEEN: Hmmm… No, unless there is a specific reason for that. Our aim is normal vaginal delivery. I’d encourage you to opt for an effective pain relief in labour, especially epidural.
S. FULAANAH: OK. What happens if I have a crisis during pregnancy?
DR. FULEEN: With good care as I’ve mentioned before, that shouldn’t happen. But if it happens, we will admit you in the hospital and treat you the same way we treat crisis outside of pregnancy. The only extra is that the obstetricians will be monitoring your baby too. If at any time your condition gets bad or the baby is in distress, we may have to terminate the pregnancy or deliver you prematurely. Again, that rarely happens and we pray it doesn’t happen.
S. FULAANAH: Aameen. Thanks so much for your time doc. I sincerely appreciate your kindness and support.
DR FULEEN: You’re welcome dear. Any time.