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Re: thalassemia in pregnancyFrom: T-H Bui, Clinical Genetics, Karolinska Hospital (bui@gen.ks.se)Tue May 28 10:01:48 1996
At 07.03 1996-05-28 -0500, Socolov Razvan wrote: >Greetings to all listers! >I am very glad that I (recently) subscribe to this list. I find it very >useful, especially for beginner in O&G, such as I am. > >Now, would I dare to ask you some advices about a case of mine: >A 21 yrs G1P1 with 30 wks pregnancy is discovered to have mild thalassemia. >For the moment, she is given iron and folic acid. >It seems like her mother could have thalassemia cases in the family, but >no appropiate exam has been performed. >It also seems that she is going to deliver a girl. > >Now, the questions: >1. Is this pregnancy a high risk one? >2. Which way of delivery would you reccommend- vaginal or by cesarean >section? >3. Any special reccommendations for the new born, as well as for the >post-partum care? >4. What are the next pregnacies prognosis? > >From your report your patient seems to be a carrier of a beta-thal mutation. You did not mention how the diagnosis on your patient (mother) was made. My guess is that you conducted an electrophoresis of her hemoglobin. Thus: ad 1. your patient herself might have a mild to moderate anemia during pregnancy. The fetus' risk of having 'thalassemia major' depends on the genotype of the father. You should screen the father for carrier status for beta-thal (Hgb-electrophoresis or DNA-analysis if available). If he is not a carrier then the fetus has a 50% risk of being a carrier but this is not of major medical concern (he/she will have thalassemia minor as the mother-to-be). ad 2. vaginal delivery. CS only for fetal indications as in other (normal) pregnancies. ad 3. special care of the newborn as indicated by conditions (not only because it is a carrier). PP care with continued folic acid and iron supplementation as long as breast feeding. Remember that anemia in a carrier cannot be corrected by iron supplementation. ad 4. if the baby is shown to have thalassemia major during the first year, then the risk is 25% for each subsequent pregnancy. If the child is normal but you don't know the carrier status of the father, the risk can still be 25%. See ad 1 above. The-Hung Bui, MD Associate Head Director Fetal Diagnosis Program Dept. of Clinical Genetics, Karolinska Hospital, S-171 76 Stockholm, Sweden Consultant Obstetrician-Gynecologist (Fetal Medicine) Dept. of OB&GYN, Huddinge University Hospital, Karolinska Institute, S-141 86 Huddinge, Sweden phone: +46 8 729 4989 (office) or 729 2472 (secretary) fax: +46 8 32 77 34; e-mail: bui@gen.ks.se
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