Babah Ochuwa Adiketu, Aderolu Monsurat Bolanle, Oluwole Ayodeji A, Afolabi Bosede B
Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Lagos; Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba; Department of Obstetrics and Gynaecology, Alimosho General Hospital, Igando, Lagos, Nigeria.
Niger Postgrad Med J. 2019 Jan-Mar;26(1):1-7. doi: 10.4103/npmj.npmj_177_18.
Sickle cell disease in pregnancy carries increased risk of maternal and perinatal morbidity and mortality. Past studies on pregnancy complications in sickle cell disease women were limited by relatively small sample sizes, and use of retrospective and hospital discharge data.
This prospective case-control study compared booked pregnant Haemoglobin (Hb) SS women with AA controls from two tertiary centres in Lagos, in order to precisely identify their complication and mortality rates and identify associated factors. Eligible pregnant HbSS and HbAA women were recruited from antenatal clinics at booking and follow-up visits. Information was collected on a proforma and data was analyzed using IBM SPSS version 20.
We found higher complication rate in HbSS group, commonest complications being vaso-occlusive crisis (RR 1.47, 95% CI 1.22 - 1.78), pregnancy induced hypertension (RR 1.31, 95% CI 1.08 - 1.57), urinary tract infection (RR 1.32, 95% CI 1.12 - 1.57), and intrauterine growth restriction (RR 1.2, 95% CI 1.05 - 1.34). HbSS group had higher systolic and mean arterial blood pressure values in early puerperium compared to HbAA group (p = 0.014 and 0.024 respectively). No maternal death recorded in both group. Incidence of low birth weight <2.5Kg was 38% in HbSS and 4% in HbAA subjects, p = 0.001. However, overall maternal and perinatal outcomes were comparable in both groups (p = 1.000).
Although sickle cell disease poses higher obstetric risk in pregnancy, maternal and perinatal outcome can be as good as in the non-sickle cell pregnant women if adequate and prompt individualized care is given to this group of women.
妊娠合并镰状细胞病会增加孕产妇和围产期发病及死亡风险。过去关于镰状细胞病女性妊娠并发症的研究受到样本量相对较小以及使用回顾性和医院出院数据的限制。
这项前瞻性病例对照研究比较了来自拉各斯两个三级中心的已预约妊娠的血红蛋白（Hb）SS型女性与AA型对照者，以便精确确定她们的并发症和死亡率，并确定相关因素。符合条件的妊娠HbSS型和HbAA型女性在预约时从产前诊所招募，并进行随访。通过表格收集信息，并使用IBM SPSS 20版软件进行数据分析。
我们发现HbSS组的并发症发生率更高，最常见的并发症是血管闭塞性危机（相对危险度1.47，95%可信区间1.22 - 1.78）、妊娠期高血压（相对危险度1.31，95%可信区间1.08 - 1.57）、尿路感染（相对危险度1.32，95%可信区间1.12 - 1.57）和宫内生长受限（相对危险度1.2，95%可信区间1.05 - 1.34）。与HbAA组相比，HbSS组在产褥早期的收缩压和平均动脉血压值更高（分别为p = 0.014和0.024）。两组均未记录到孕产妇死亡。HbSS组低出生体重<2.5kg的发生率为38%，HbAA组为4%，p = 0.001。然而，两组的总体孕产妇和围产期结局相当（p = 1.000）。
尽管镰状细胞病在妊娠期间带来更高的产科风险，但如果对这组女性给予充分且及时的个体化护理，孕产妇和围产期结局可以与非镰状细胞病妊娠女性一样好。
