Читать книгу Protocols for High-Risk Pregnancies - Группа авторов - Страница 142

 Early establishment of care with obstetrician, maternal‐fetal medicine specialist, and hematologist/SCD provider.

 Stop hydroxyurea and ACE inhibitors if not previously discontinued.

 Obtain baseline maternal serum labs including CBC, reticulocyte counts, lactate dehydrogenase, liver function tests, renal function tests, iron studies, urinalysis/urine culture.

 Maternal echocardiogram if the patient has a history of multiple crises and/or acute chest syndrome as these patients are at increased risk of pulmonary hypertension. There is currently not enough evidence to make a recommendation on universal pulmonary hypertension screening in this population.

 Paternal screening (hemoglobin electrophoresis and/or alpha‐thalassemia genetic screening) if not previously completed for risk assessment of fetal genetic inheritance.

 Referral to genetic counseling if father is a carrier or if paternity is unknown/unable to be tested.

 Early ultrasound to confirm viability of the pregnancy.

 Pregnancy options counseling.

 Laboratory monitoring every trimester (CBC, urine culture).

 Detailed anatomical survey at 18–20 weeks.

 Serial growth ultrasounds every month; add fetal surveillance if fetal growth restriction develops.

 Consider daily aspirin for preeclampsia prevention.

 Maternal BP monitoring.

 Lab evaluation if concern for crisis (increased pain) including CBC, reticulocyte count, lactate dehydrogenase, haptoglobin, urinalysis, urine culture.

 Discuss maternal immunization as SCD causes patients to be functionally asplenic. Patients with SCD should receive the following (in conjunction with SCD provider). All below immunizations are safe in pregnancy.Haemophilus influenzae type B (Hib) vaccine: one dose during their lifetime.Meningococcal vaccine: two‐dose series at least eight weeks apart initially and revaccination every five years.Pneumococcal vaccine: one dose of PCV13 followed by one dose PPSV23 at least eight weeks later. Repeat PPSV23 five years after initial PPSV23.Yearly influenza vaccine.

 Folic acid supplementation (4 mg/day).