During the 10 years, nine spontaneous pregnancies,all planned, occurred in five women with TI. One woman had three pregnancies and two women had two pregnancies. Six pregnancies (67%) resulted in live newborns; 2 (22%) were complicated by first-trimester abortions and one (11%) by an unexplained intrauterine fetal death (IUFD) at 36 weeks’ gestation. This patient had an uncomplicated antenatal course with a reactive non-stress test 1 week prior to presentation
with decreased fetal movement. She never received transfusions and her Hb was maintained at 9.0 g/dl.None of the patients had thyroid dysfunction or pregestational or gestational diabetes mellitus. Since all pregnancies were planned, none of the patients was on iron chelation at conception. The four patients who were receiving deferoxamine had it interrupted 2–7 months prior to conception. Patients’ characteristics and obstetric data are summarized in Table I.
The mean maternal age was 29.6±5.5 years with a median parity of 1 [1–3]. The mean lowest hemoglobin level was 5.2±2.0 g/dl and the mean number of transfusions received was 8.0±5.2 units. Three patients had received transfusions before pregnancy, and
two required them for the first time during pregnancy.Both patients who received their first transfusion in pregnancy developed alloantibodies, which contributed to worsening of their anemia and repeated transfusions ante- and intrapartum. This eventually necessitated
splenectomy postpartum: one at 312/7 weeks’ gestation following cesarean delivery and the other about 8 weeks postpartum for worsening anemia, thrombocytopenia, and a persistently positive Coombs test.Both patients who had splenectomy prior to pregnancy never received hydroxyurea (HU). None of the patients had hemodynamic abnormalities. The mean ferritin level was 978±935 mg/L (130-2,366 mg/L).Cesarean delivery was performed in 42.9% of cases. The mean gestational age at delivery was 36.7±3.1 weeks. The mean birth weight was 2282±589 g with
IUGR complicating 57.1% of cases. No congenital malformations were observed in our series. We noted that the two cases of spontaneous abortions and three of four IUGR cases occurred in splenectomized patients