Diaphragms are usually less effective, however, may be satisfactory if combined with a spermicidal preparation. Progesterone based prevention by pill or depo preparations is also effective. Fathers should always be tested and the risk of having an affected child determined. It is very important to do both a CBC with indices and hemoglobin electrophoresis to detect structural hemoglobin variants and thalassemias. Non-directive counseling should be provided with information about prenatal diagnosis.
Termination of pregnancy is accomplished by suction curettage in the first thirteen weeks.
Hypertonic urea with prostaglandin F2 is safe in later pregnancies. Hypertonic saline induction should be avoided because of the potential for causing increased sickling that can theoretically cause complications. All preadolescent children should receive information about prevention of pregnancy and sexually transmitted diseases. This should be periodically reinforced during the reproductive years. Patients who want children should be provided with accurate information about the potential for increased problems during pregnancy, the increased rate of spontaneous abortions, the risk for have affected children, and the physical and psychological stress associated with parenthood.