Chase A R, Sohal M, Howard J, Laher R, McCarthy A, Layton D M, Oteng-Ntim E
Women's Health Department, Guy's and St Thomas' Hospital NHS Foundation Trust.
Department of Haematology, Imperial College Healthcare NHS Trust.
Obstet Med. 2010 Sep;3(3):110-2. doi: 10.1258/om.2010.100026. Epub 2010 Sep 17.
The objective of this retrospective cohort study from two tertiary centres in the UK was to describe the pregnancy outcomes of women with sickle cell disease (SCD) who booked at these centres between 2004 and 2008, and to compare this with historical data. The study population comprised 122 singleton pregnancies in women with SCD: homozygous sickle cell disease 64, sickle cell haemoglobin C disease 45, sickle b plus thalassaemia 11, sickle cell haemoglobin E disease 1 and sickle cell delta disease 1 from 2004 to 2008 managed in the joint haematology/obstetric antenatal clinics in two tertiary teaching hospitals. The main outcome measures were the frequency of sickle cell crises and obstetric complications. Age and gestation at booking were 18-43 years (mean 29.7) and 9-36 weeks gestation (mean 17.3), respectively. Complications of SCD occurred in 25% of pregnancies. Fifty-four percent of women had induction of labour and 39% were delivered by emergency caesarean section. Thirty-three percent had a postpartum haemorrhage. Nineteen percent of women delivered before 37 completed weeks. Birth weight below 2500 g occurred in 20% of singleton pregnancies. Three neonates developed transient complications related to maternal opiate exposure postnatally. Three intrauterine deaths occurred at 24, 29 and 34 weeks. Two of these had congenital defects, and the other severe intrauterine growth restriction. No maternal deaths occurred. Successful pregnancy outcomes can be achieved in SCD. There has been an improvement in fetal and maternal morbidity and mortality compared with historical data. Pregnancy in women with SCD remains high risk. Early access to antenatal care and to expertise in SCD is essential. A matched control population from the same time period and prospective data collection is needed to address confounders such as ethnicity and deprivation.
这项来自英国两个三级医疗中心的回顾性队列研究的目的是描述2004年至2008年期间在这些中心登记建档的镰状细胞病（SCD）女性的妊娠结局，并将其与历史数据进行比较。研究人群包括122例SCD女性的单胎妊娠：2004年至2008年期间，在两家三级教学医院的血液科/产科联合产前门诊管理的纯合子镰状细胞病64例、镰状细胞血红蛋白C病45例、镰状β加地中海贫血11例、镰状细胞血红蛋白E病1例和镰状细胞δ病1例。主要结局指标为镰状细胞危象和产科并发症的发生率。登记建档时的年龄和孕周分别为18 - 43岁（平均29.7岁）和9 - 36周妊娠（平均17.3周）。25%的妊娠发生了SCD并发症。54%的女性引产，39%通过急诊剖宫产分娩。33%发生产后出血。19%的女性在妊娠满37周前分娩。20%的单胎妊娠出生体重低于2500 g。3例新生儿出生后出现与母亲阿片类药物暴露相关的短暂并发症。发生3例宫内死亡，分别在24、29和34周。其中2例有先天性缺陷，另1例有严重的宫内生长受限。无孕产妇死亡。SCD女性可以实现成功的妊娠结局。与历史数据相比，胎儿和孕产妇的发病率及死亡率有所改善。SCD女性妊娠仍属高危。尽早获得产前护理和SCD方面的专业知识至关重要。需要来自同一时期的匹配对照人群和前瞻性数据收集，以解决种族和贫困等混杂因素。
