a It is important to ask about the frequency of sickling crises and any previous blood transfusion, cardiac function as heart failure ,renal for nephropathy ,lung function for pulmonary hypertension shoud be assessed for end organ damage ,so she shoud be referred to a physician .Pregnancy contraindicated if she has pulmonary hypertension as maternal mortality approaches 50% . She shoud be advised to continue her antibiotic prophylaxis ,to be up todate vaccination hep B, influanza, and pneumococal .Folic acid dose 5 mg daily .Her partner should be screened for SCD in order to estimate risk to the baby
antenatal care should be managed by a multi discliplipinary team haematologist an anasthetist and obstetrician adviced to take folic acid 5 mg, penicilln v 250mg b.d ,up to date with vaccination hepatitis B pneumococal .THE maternal and fetal risks should be explained,she should be encoureged to avoid dehydration and cold environment as they trigger sickling crises
B offer muli discilpinary team senior midwife senior obstetrian anasthetist haematologist
aim for vaginal delivery offer delivery in obstetric unit that able to manage comlications of sickle cell disease ,cross match if there are a typical antibodes other wise group and save .In woman with hip replacement it is important to discuss suitable position ,start continuos fetal monitering as increase risk of fetal distress keep woman warm and well hydrated aviod use of pethidine as it cause seizures
