Evidence to establish the beneficial and harmful effects of interventions for treating painful sickle crisis during pregnancy is lacking.
Sickle cell disease covers a group of inherited (genetic) haemoglobin disorders that cause a defect in red blood cells. The disease has been declared by WHO as a major world health problem.
The changes in the red blood cells can lead to damaged and blocked blood vessels. The most frequent complication of sickle cell disease is a painful vaso-occlusive crisis. Treatment may involve the non-surgical intervention with packed red cell transfusion, fluid replacement therapy, analgesic drugs (nonsteroidal anti-inflammatory agents or opiates), oxygen therapy and steroids (prednisone, dexamethasone, or methylprednisolone). Pregnant women with sickle cell disease have an increased incidence of sickle cell crises. Their unborn infants are also at high risk of illness and death. The effectiveness and safety of the different treatments is, therefore, particularly important. For example, sickle cell disease can lead to severe placental damage, yet the opiate morphine constricts the blood vessels in the placenta and so may harmful to the fetus.
The review authors searched the medical literature for randomised controlled trials in which non-surgical approaches were compared for their efficacy and safety. They could not find any randomised clinical trials on non-surgical interventions for the treatment of painful sickle cell crisis during pregnancy. Pregnant women were excluded from clinical trials studying opiate or non-opiate analgesics for treating painful sickle cell crisis.