Arch Gynecol Obstet (2008) 278:101–102 DOI 10.1007/s00404-008-0650-3 123 LETTER TO THE EDITOR Optimizing antenatal care and delivery in thalassemic mothers: single center experience Neeta Singh · Deepika Deka · Vatsla Dadhwal · Nupur Gupta · Suneeta Mittal Received: 22 February 2008 / Accepted: 1 April 2008 / Published online: 17 April 2008  Springer-Verlag 2008 Dear Editors: Genetically determined autosomal recessive haemoglobin- opathies are mostly caused due to point mutations. They are characterized by impaired production of one or more nor- mal globin peptide chains, which results in ineVective erythropoiesis and anemia. Prevalence and severity is popu- lation dependent.  Thalassemia is caused by decreased production of beta globin chains; both in homozygous ( thalassemia major) and heterozygous ( thalassemia minor). In  thalassemia trait, haemoglobin A2 is more than 3.5% and haemoglobin F more than 2% with mild microcy- tic hypochromic anaemia (mean corpuscular haemoglobin <80 X, and serum ferritin >12 ng/L). The aim of this study was to evaluate retrospectively the maternal and perinatal outcome of women with thalassemia minor and intermedia and to analyze its optimum antenatal management. All booked pregnant women who were known cases of thalas- semia trait, referred or diagnosed during pregnancy were analyzed from January 2002 to December 2005 in the our department. Data were collected from perinatal database from information recorded after delivery by the resident. The incidence of thalassemia was 0.75% (19 women out of 2,520); 94.7% thalassemia minor and 5.3% thalassemia intermedia; 10.5% (n = 2) were found to have other associ- ated haemoglobinopathies. The characteristics of thalasse- mic patients are shown in Table 1. All patients were given 100 mg elemental iron for 100 days and 5 mg folic acid as per the recommendation of Government of India; 16% required additional blood transfusion. In 31.5% women (n = 6), previous babies were aVected with thalassemia major and 68.4% (n = 13) husbands had thalassemia trait, thus were oVered prenatal diagnosis. Chorion villous sam- pling was done in 94%, and cordocentesis in 6%. Mean gestational age at delivery was 35.6 § 2.2 weeks. Caesar- ean section was performed in 47.3% (n = 9) of women and 52.5% (n = 10) of women delivered vaginally. The indica- tions were as follows: persistent fetal bradycardia (n = 2), contracted pelvis (n = 1), previous caesarean with non pro- gress of labor (n = 1), severe intrauterine growth restriction with poor biophysical proWle (n = 2), severe preeclampsia with failed induction (n = 2) and cervical dystocia (n = 1). Intrauterine growth restriction was seen in four patients. One patient underwent caesarean hysterectomy at 36 weeks due to uncontrolled atonic post partum haemorrhage caused by placenta accreta. Nassar et al. reviewed outcome of nine pregnancies in women with thalassemia intermedia over a 10-year period and concluded that IUGR (intrauterine growth restriction) complicated more than half of all preg- nancies; transfusion was required in most cases and some needed postpartum splenectomy [1]. Sheiner et al. investi- gated the pregnancy outcome of patients with  thalassemia minor during 1988¡2002 and found the overall incidence to be 0.2%. There was high association with oligohydram- nios, IUGR with a favorable perinatal outcome [2]. To con- clude, screening for thalassemia and its prenatal diagnosis may prevent the occurrence of newborns aVected with thal- assemia. N. Singh · D. Deka · V. Dadhwal · N. Gupta · S. Mittal Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi 110048, India N. Gupta (&) D-34, Pamposh Enclave, Greater Kailash-1, New Delhi 110048, India e-mail: nupurkothari2000@yahoo.com