Patients should be monitored carefully in antenatal clinics and delivered in hospital. Iron and folic acid supplementation is standard practice since the requirements of these are increased by pregnancy. Chronic transfusion is commonly performed from the middle trimester; although there is no evidence of fetal benefit, the risks of painful crises and acute chest syndrome in the mother may be reduced. The obstetric experience of centers using transfusion therapy does not differ markedly from those which do not. The management of the painful crisis and acute chest syndrome is similar to that in non-pregnant patients, although delivery may be induced if the acute chest syndrome appears life threatening. Delivery is normally by the vaginal route unless there are obstetric indications for operative delivery.
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