Shulman C E, Levene M, Morison L, Dorman E, Peshu N, Marsh K
Disease Control and Vector Biology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Trans R Soc Trop Med Hyg. 2001 May-Jun;95(3):250-5. doi: 10.1016/s0035-9203(01)90227-5.
Severe anaemia in pregnancy is an important preventable cause of maternal and perinatal morbidity and mortality. Different methods of screening for severe anaemia in pregnancy were evaluated in a 2-phased study conducted in Kilifi, Kenya. In phase 1 (in 1994/95), pallor testing was evaluated alone and in addition to raised respiratory/pulse rates: 1787 pregnant women were examined by one of 2 midwives. Sensitivities for detecting severe anaemia (haemoglobin < 7 g/dL) were 62% and 69% and specificities 87% and 77%, respectively for each of the midwives. Addition of high pulse rate increased sensitivity to 77% and 81%, but specificity reduced to 60% and 51%, respectively. In phase 2, following qualitative in-depth work, a screening questionnaire was developed. An algorithm based on screening questions had 80% sensitivity and 40% specificity. Midwife pallor-assessment was conducted following the screening questionnaire. In this phase (conducted in 1997), the midwife performed very highly in detecting severe anaemia, achieving sensitivity of 84% and specificity of 92%. Spending a few minutes asking women questions may have improved the ability to interpret pallor findings. This study demonstrates the value of pallor testing and raises alternative approaches to improving it.
妊娠期重度贫血是孕产妇和围产期发病及死亡的一个重要可预防原因。在肯尼亚基利菲进行的一项分两阶段的研究中，对妊娠期重度贫血的不同筛查方法进行了评估。在第一阶段（1994/1995年），单独评估了面色苍白检测以及除呼吸/脉搏率升高之外的面色苍白检测：1787名孕妇由两名助产士之一进行检查。每名助产士检测重度贫血（血红蛋白<7g/dL）的敏感度分别为62%和69%，特异度分别为87%和77%。加上高脉搏率后，敏感度分别提高到77%和81%，但特异度分别降至60%和51%。在第二阶段，经过定性深入研究后，制定了一份筛查问卷。基于筛查问题的算法敏感度为80%，特异度为40%。在筛查问卷之后进行助产士面色苍白评估。在这一阶段（1997年进行），助产士在检测重度贫血方面表现非常出色，敏感度达到84%，特异度达到92%。花几分钟询问女性问题可能提高了对面色苍白检查结果的解读能力。这项研究证明了面色苍白检测的价值，并提出了改进它的替代方法。
