Postnatal complications
and breastfeeding issues
For most pregnant women with thalassaemia,
birth is uncomplicated and requires similar
intrapartum care to that provided for other
women. Postnatally, however, surveillance and
monitoring is required as there is an increased
risk of unstable coagulopathies (Davis, 2014).
Postpartum haemorrhage and symptoms
associated with excessive bleeding can be a
concern, and blood transfusion may be indicated
if Hb levels are significantly low. Conversely,
women can also be at risk of developing venous
thromboembolism owing to a potentially
hypercoagulable state. Heparin prophylaxis is
recommended for 6 weeks postpartum in these
women to prevent the risk of abnormal clotting
and embolism (Eissa and Tuck, 2013).
Iron chelation therapy should be recommenced
within 24 hours of birth to facilitate return of
normal iron levels. Deferoxamine is the preferred
choice of medication as this can be administered
orally and does not interfere with breastfeeding
or transfer across to the neonate. Women
require follow-up management of additional
complications that developed throughout
pregnancy. Diabetes mellitus, cardiomyopathies
and organ dysfunction require specialist care
and collaboration between health professionals
to optimise maternal wellbeing and return
of haemostasis during the postnatal period
(Voskaridou et al, 2014).