Taylor Michelle Y, Wyatt-Ashmead Josephine, Gray Jermaine, Bofill James A, Martin Rick W, Morrison John C
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi, USA.
South Med J. 2008 Feb;101(2):150-1. doi: 10.1097/SMJ.0b013e31816122ea.
Traditionally, sickle cell trait has not been associated with a higher risk of fetal death, but we noted several, which led us to assess all such pregnancies.
In this retrospective study, 131 patients with sickle cell trait were analyzed over a two-year period. The Institutional Review Board approved the collection of deidentified data.
Subjects were African-American with an average age of 23.9 years, and average gestational age at delivery of 30.1 weeks. There were 10 (8.13%) intrauterine fetal deaths (IUFDs), and one neonatal death. Ascending amniotic fluid infection was noted in 50% and 92% meconium histocytes. All placentas had sickling in the intervillous space and the decidual vessels.
Sickling in the decidual vessels and poor placental perfusion may play a role in pregnancy loss in excess of what has previously been reported. A cohort control study appears to be in order.
Pregnant women with sickle cell trait are thought not to have increased maternal or fetal mortality/morbidity. Over a two year period, we studied 131 women with this hemoglobinopathy and found that 10.6% had intrauterine growth retardation (IUGR), 8.4% preterm premature rupture of the membranes, 8.1% intrauterine fetal demise (n = 10) at most occurring at 16 to 24 weeks, and one neonatal death. Amniotic fluid infection was noted in 50%, and meconium histocytes indicating intrauterine hypoxia were noted, as was unsuspected sickling in the placental vasculature. Based on this case series, sickle cell trait may not be as benign for the fetus as was previously thought.
传统上，镰状细胞性状与胎儿死亡风险升高并无关联，但我们注意到了几例相关情况，这促使我们对所有此类妊娠进行评估。
在这项回顾性研究中，对131例具有镰状细胞性状的患者进行了为期两年的分析。机构审查委员会批准了对去识别化数据的收集。
研究对象为非裔美国人，平均年龄23.9岁，分娩时平均孕周30.1周。有10例（8.13%）宫内胎儿死亡（IUFDs），1例新生儿死亡。50%的病例出现羊水上行感染，92%的病例出现胎粪组织细胞。所有胎盘的绒毛间隙和蜕膜血管均有镰状化。
蜕膜血管镰状化和胎盘灌注不良可能在妊娠丢失中起作用，其程度超过先前报道。似乎有必要进行一项队列对照研究。
患有镰状细胞性状的孕妇被认为不会增加孕产妇或胎儿的死亡率/发病率。在两年时间里，我们研究了131例患有这种血红蛋白病的女性，发现10.6%有宫内生长受限（IUGR），8.4%有胎膜早破，8.1%有宫内胎儿死亡（n = 10），大多数发生在16至24周，1例新生儿死亡。50%的病例出现羊水感染，发现有胎粪组织细胞提示宫内缺氧，胎盘血管中也有未被怀疑的镰状化。基于这个病例系列，镰状细胞性状对胎儿可能不像以前认为的那么无害。
