| Abstract [eng] |
Background. Thalassemia is an inherited hemoglobinopathy characterized by impaired synthesis of globin chains. Due to increasing migration, this disease is becoming an increasingly relevant issue in non-endemic regions, including Lithuania. Pregnancy in women with beta-thalassemia is a high-risk condition: physiological hemodilution exacerbates the pre-existing chronic anemia, leading to a need for repeated transfusions, and can cause complications for both the mother and the fetus. Aim of the study. To evaluate the specific aspects of pregnancy care, correction of hematological parameters, and delivery management in a pregnant woman with beta-thalassemia, based on a clinical case and the latest scientific literature data. Objectives: 1. To review the literature data on the pathophysiology, diagnostic principles, and impact of beta-thalassemia on maternal and fetal status; 2. To evaluate the clinical case of a patient with thalassemia; 3. To evaluate the delivery management strategy in the presence of concurrent obstetric pathologies and a previous Cesarean section; 4. To determine the effectiveness of multidisciplinary monitoring on maternal and neonatal outcomes. Methods. A scientific literature search was conducted in international databases (publications from 2017–2025). To substantiate the epidemiological data, one additional earlier article was included. Priority was given to systematic reviews, meta-analyses, and international clinical guidelines. For the clinical case analysis, approval from the Ethics Committee of Vilnius University Hospital Santaros Klinikos and informed patient consent were obtained. Results. The case of a second pregnancy in a 33-year-old patient with beta-thalassemia-minor was analyzed. During pregnancy, progressive anemia required three blood transfusions (a total of 6 units of packed red blood cells). The day before hospital admission, the hemoglobin level was 88 g/L. The patient was hospitalized at 39+1 weeks of gestation due to the rupture of membranes. Upon admission, the hemoglobin level was 90 g/L, and fetal Doppler indices were within normal limits. A pre-delivery transfusion (2 units of packed red blood cells) was administered, raising the hemoglobin to 105 g/L. Following a diagnosis of inadequate labor activity, an oxytocin infusion was administered. Despite a history of a previous Cesarean section, the patient successfully delivered vaginally. A full-term female neonate weighing 3330 g was delivered with Apgar scores of 10/10. In the postpartum period, a cervical tear and an episiotomy were sutured. The patient was discharged in satisfactory condition on the second postpartum day. According to literature data, up to one-third of pregnant women with beta-thalassemia minor experience severe anemia (hemoglobin below 90 g/L) in the third trimester, and this case illustrates that with appropriate multidisciplinary management, favorable maternal and neonatal outcomes are achievable. Conclusions. This clinical case emphasizes the importance of multidisciplinary collaboration in the care of pregnant women with beta-thalassemia and demonstrates that with appropriate hematological management, favorable maternal and neonatal outcomes, including a safe vaginal delivery, are possible. Beta-thalassemia-minor should not be considered an asymptomatic condition during pregnancy—it may require monitoring as intensive as that for more severe forms of the disease. |
