Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital, Perth, WA, Australia.
Int J Obstet Anesth. 2021 Aug;47:102985. doi: 10.1016/j.ijoa.2021.102985. Epub 2021 Mar 29.
Antepartum anemia impacts over a third of pregnant women globally and is associated with major maternal and perinatal morbidity, including peripartum transfusion, maternal death, maternal infection, preterm birth, and neurodevelopmental disorders among offspring. Postpartum anemia impacts up to 80% of women in low-income and rural populations and up to 50% of women in Europe and the United States, and is associated with postpartum depression, fatigue, impaired cognition, and altered maternal-infant bonding. Iron deficiency is the most common cause of maternal anemia because of insufficient maternal iron stores at the start of pregnancy, increased pregnancy-related iron requirements, and iron losses due to blood loss during parturition. Anemic women should undergo testing for iron deficiency; a serum ferritin cutoff level of 30 μg/L is commonly used to diagnose iron deficiency during pregnancy. The first-line treatment of iron deficiency is oral iron. Intravenous iron is a consideration in the following scenarios: a poor or absent response to oral iron, severe anemia (a hemoglobin concentration <80 g/L), rapid treatment for anemia in the third trimester, women at high risk for major bleeding (such as those with placenta accreta), and women for whom red blood cell transfusion is not an option. Given the high prevalence of antepartum and postpartum anemia, anesthesiologists are advised to partner with other maternal health professionals to develop anemia screening and treatment pathways.
全球超过三分之一的孕妇患有产前贫血，与产妇和围产期发病率高有关，包括围产期输血、产妇死亡、产妇感染、早产和后代神经发育障碍。产后贫血影响高达 80%的低收入和农村地区妇女以及高达 50%的欧洲和美国妇女，与产后抑郁、疲劳、认知障碍和母婴关系改变有关。缺铁是导致产妇贫血的最常见原因，原因是妊娠开始时母体铁储备不足、妊娠相关铁需求增加以及分娩时失血导致铁丢失。贫血妇女应进行缺铁检测；血清铁蛋白截断值为 30μg/L 常用于诊断妊娠期缺铁。缺铁的一线治疗是口服铁。以下情况下考虑静脉铁：口服铁反应不佳或无效、严重贫血（血红蛋白浓度<80g/L）、第三孕期贫血快速治疗、有大出血高危风险的妇女（如胎盘植入的妇女）以及不能进行红细胞输血的妇女。鉴于产前和产后贫血的高患病率，建议麻醉师与其他产妇健康专业人员合作，制定贫血筛查和治疗途径。
