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
During the 10 years, nine spontaneous pregnancies,all planned, occurred in five women with TI. Onewoman had three pregnancies and two women hadtwo pregnancies. Six pregnancies (67%) resulted in livenewborns; 2 (22%) were complicated by first-trimesterabortions and one (11%) by an unexplained intrauterinefetal death (IUFD) at 36 weeks’ gestation. Thispatient had an uncomplicated antenatal course with areactive non-stress test 1 week prior to presentationwith decreased fetal movement. She never receivedtransfusions and her Hb was maintained at 9.0 g/dl.None of the patients had thyroid dysfunction orpregestational or gestational diabetes mellitus. Sinceall pregnancies were planned, none of the patients wason iron chelation at conception. The four patientswho were receiving deferoxamine had it interrupted2–7 months prior to conception. Patients’ characteristicsand obstetric data are summarized in Table I.The mean maternal age was 29.6±5.5 years with amedian parity of 1 [1–3]. The mean lowest hemoglobinlevel was 5.2±2.0 g/dl and the mean number oftransfusions received was 8.0±5.2 units. Three patientshad received transfusions before pregnancy, andtwo required them for the first time during pregnancy.Both patients who received their first transfusion inpregnancy developed alloantibodies, which contributedto worsening of their anemia and repeated transfusionsante- and intrapartum. This eventually necessitatedsplenectomy postpartum: one at 312/7 weeks’ gestationfollowing cesarean delivery and the other about8 weeks postpartum for worsening anemia, thrombocytopenia,and a persistently positive Coombs test.Both patients who had splenectomy prior to pregnancynever received hydroxyurea (HU). None of thepatients had hemodynamic abnormalities. The meanferritin 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±3.1weeks. The mean birth weight was 2282±589 g withIUGR complicating 57.1% of cases. No congenitalmalformations were observed in our series. We notedthat the two cases of spontaneous abortions andthree of four IUGR cases occurred in splenectomizedpatients
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