Maternal morbidity and mortality associated with mode of delivery in Sickle cell disease: an observational study

Objective: To compare pregnancy outcomes based on mode of delivery in women with homozygous sickle cell disease (HbSS) to women without (HbAA). Design and setting: Retrospective observational study was performed using delivery records of 48,600 parturients between January 1992 and January 2020 at a Jamaican hospital. Methods: We identified 250 women with HbSS and 252 age-matched with AA phenotype. Stratification based on mode of delivery revealed: 150 vaginal and 105 caesarean deliveries (HbSS), 185 vaginal and 67 caesarean deliveries (HbAA). Fisher’s exact tests and Mann-Whitney test were used to analyze variables based on sickle cell status. Unadjusted and adjusted odds ratios were calculated based on mode of delivery. Main outcome measures: Maternal and perinatal morbidity in women with HbSS and HbAA genotypes exposed to vaginal or caesarean section delivery. Results: Vaginal delivery and HbSS were more associated with labour induction/augmentation (AOR= 2.4, (0.7–7.8)), intrapartum complications (AOR= 2.6, (0.5–14), postpartum hemorrhage (AOR= 2.8 (0.5–15.2)), and postpartum infections (AOR= 9.6 (1.7–54.4)). Caesarean delivery resulted in more postpartum infections in the HbSS group (AOR = 23.6 (0.9 – 638.4)). There were no differences in rates of neonatal deaths (n (%); 3 (4) vs. 0(0), p=0.250); or stillbirths between the groups. Conclusion: Vaginal delivery in HbSS resulted in more intrapartum complications, postpartum hemorrhage, hypertensive disorders, and postpartum infections. Cesarean delivery in HbSS increases the risk of postpartum infections and hypertensive disorders. There was no increased risk of adverse perinatal outcomes regardless of mode of delivery.