Protocols - Hemorio

(6) multiple pregnancies
(7) smoking, alcohol and narcotics.
LABOR AND CHILDBIRTH:
- To allow painkillers (see pain treatment on gestational period)
- Peridural anesthesia
- O2 and liquids reposition
- Fetal monitoring
- Cesarean by obstetric indication is common, being necessary pre-surgical transfusional preparation.
- Avoid thromboembolism with early walking around, elastic socks, hydration and newborn cares.
PRETERM LABOR: The gestational age is smaller in the fetus whose mother has Falciform Disease. The
media gestational age is 36 weeks.
Implicated factors: Anemia, DPP, previous placenta, toxemia, multiple gestations, urinary tract infection,
chorioamnionitis, smoking and narcotics.
PERINATAL MORTALITY: is increased in Falciform Disease, ranging from 20 to 50%.
RESULTS IMPROVEMENT: The principal factor to reduce mortality is neonatal care. The specialized
attendance to the mother, which includes ultrasound, biophysical profile, Umbilical cord Doppler, cesarean
with obstetrician indication. Transfusions in special cases must be discussed along with Hemotherapy.
Great lesions in the placenta that occur earlier do not benefit form late transfusions..
PLACENTA CHANGE - DPP and Previous Placenta have increased incidence, being attributed to
continuing vase-oclusion, decidute arterioles thrombosis, necrosis and subsequent venous hemorrhage by
toxemia.
COMPLICATION DURING PREGNANCY
- Episode of vase-occlusive crisis –may increase, especially, at the end of pregnancy period.
Prophylactic transfusions only for episodes of non-justified pain.
- Pain Crisis _ also see “Pain Approach” – chapter III)
- Anemia – there is an aggravation in the picture for increase of demand, hemodilution, medulla
suppression, infection or inflammation, vitamin or iron deficiency and aplastic crisis.
- Infections – increased frequency at the 1 st half of gestational period, mainly in the urinary tract and
respiratory system.
- Bacteriurias must be treated. They cause CIUR and premature labor.
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