Outcome of Pregnancies Among Sickle Cell Patients Admitted to Cotonou University Hospitals (Benin) from 2008 to 2018

Abstract

Objective: Study the fetal-maternal and neonantal prognosis of sickle cell pregnancies managed in Cotonou’s hospitals (R. Benin). Material and methods: This is a descriptive study on retrospective data from January 2008 to December 2018. The maternities of the Lagoon Mother and Child Hospital and University (CHU-MEL) center and of the CNHU/HKM gynecology and obstetrics university clinic had served as a framework. Complete patients records were analyzed. Included were pregnant women or delivered at 28 weeks of amenorrhea (AW) or beyond, sickle cell disease SS or SC confirmed by hemoglobin electrophoresis. Sociodemographic, clinical, therapeutic, and fetal-maternal and neonatal prognosis were analyzed. EPI DATA 3.1 and SPSS 2.0 software were used to analyze our data. The difference is significant for a p-value ≤ 5%. Ethical and professional standards and rules were respected. Results: The delivery of a patient suffering from sickle cell disease represented 0.82% of births. The SS phenotype was observed in 27.3% (n=105) versus 72.7% (n=279) of SC (p=0.000). A history of obstetric complications was noted in 56.8% (n=218). The course of the current pregnancy was marked by obstetric complications in 97.4% and the most important were: the threat of premature delivery (28%) and the vaso-occlusive crisis (19.5%). The caesarean was performed in 92% of sickle cell patients. Premature delivery was observed in 60% with 6.3% very premature (28-33AW). It was registered 91% (n=352) live births, 48% (n=169) hypotrophs, 60% premature, 1.1% (n=4) intrapartum deaths and 8% (n=4) intrapartum deaths and 8% (n=31) deaths in utero. Perinatal mortality represented 9%. The after-effects of childbirth were complicated in 12% (n=46). The puerperal infections (32.6%), hypertension (28.2%) and its complications and severe anemia (19.2%) were the most common complications. Five (5) maternal deaths were deplored, ie a mortality rate of 1420 maternal deaths per 100,000 live births. Conclusion: In Benin, pregnancy and delivery of sickle cell disease are at high risk of fetal, maternal and neonatal mortality. Caesarean section was almost routine in this group. The practice of transfusion exchange or bleeding may improve prognosis.