Maternal and Child Health Research Center, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Maternal and Child Health Research Center, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Am J Obstet Gynecol MFM. 2022 Mar;4(2):100533. doi: 10.1016/j.ajogmf.2021.100533. Epub 2021 Nov 20.
In randomized trials, antepartum intravenous iron sucrose is effective at improving predelivery hemoglobin in iron deficiency anemia. Yet, there is a gap between this knowledge and its implementation into care.
We aimed to determine if the implementation of a standardized protocol for the management of antepartum anemia outside of a clinical trial improves intravenous iron sucrose utilization and clinical outcomes.
We performed a prospective cohort study evaluating the incorporation of an anemia protocol into routine clinical care for women with antepartum hemoglobin <11.0 g/dL. Our protocol, developed with multidisciplinary stakeholders, included (1) serial third trimester hemoglobin assessment, (2) oral iron supplementation for antepartum hemoglobin 9.5-11 g/dL, and (3) antepartum intravenous iron sucrose use (300 mg weekly for 3 weeks) for hemoglobin <9.5 g/dL. We compared 6-months preimplementation (January 2018 to June 2018) to 6-months postimplementation (January 2019 to June 2019). The outcomes evaluated were antepartum intravenous iron sucrose utilization, the number of intravenous iron sucrose dosages, predelivery hemoglobin, and blood transfusion.
A total of 1423 women were included (pre=778; post=645) without significant baseline differences. The antepartum hemoglobin nadir was no different between the groups (pre: 10.2; interquartile range [9.6-10.6] vs post: 10.2; interquartile range [9.6-10.6]; P=.77). The implementation of a standardized protocol for the management of antepartum anemia was associated with 80% increased odds of receiving intravenous iron sucrose than the preimplementation group (pre: 4.8% vs post: 8.2%, P=.008; odds ratio, 1.79; 95% confidence interval, [1.16-2.77]). The implementation of a standardized protocol for the management of antepartum iron deficiency anemia was also associated with higher hemoglobin at admission for delivery (pre: 10.9; interquartile range [10.1-11.6] vs post: 11.0; interquartile range [10.3-11.7], P=.048). There were no significant differences between the groups in blood product transfusion (pre: 7.1% vs post: 5.1%, P=.13).
Implementation of a standardized antepartum anemia protocol is associated with increased intravenous iron sucrose utilization and improvement in predelivery hemoglobin.
在随机试验中，产前静脉注射蔗糖铁可有效提高缺铁性贫血患者的分娩前血红蛋白水平。然而，这种知识与实际应用之间存在差距。
我们旨在确定在临床试验之外实施标准化的产前贫血管理方案是否能提高静脉注射蔗糖铁的利用率并改善临床结局。
我们进行了一项前瞻性队列研究，评估将贫血方案纳入有产前血红蛋白 <11.0 g/dL 的女性常规临床护理中的效果。我们的方案由多学科利益相关者制定，包括（1）孕晚期每三个月评估一次血红蛋白，（2）对于 9.5-11 g/dL 的产前血红蛋白，给予口服铁补充剂，（3）对于 <9.5 g/dL 的产前血红蛋白，给予静脉注射蔗糖铁（每周 300 mg，持续 3 周）。我们将 6 个月的实施前（2018 年 1 月至 2018 年 6 月）与实施后（2019 年 1 月至 2019 年 6 月）进行比较。评估的结局包括产前静脉注射蔗糖铁的利用率、静脉注射蔗糖铁的剂量数、分娩前血红蛋白和输血。
共纳入 1423 名女性（实施前：778 名；实施后：645 名），两组患者基线无显著差异。两组的产前血红蛋白最低值无差异（实施前：10.2；四分位距 [9.6-10.6] vs 实施后：10.2；四分位距 [9.6-10.6]；P=0.77）。实施产前贫血管理标准化方案与接受静脉注射蔗糖铁的几率增加 80%相关，高于实施前组（实施前：4.8% vs 实施后：8.2%，P=0.008；比值比，1.79；95%置信区间，[1.16-2.77]）。实施产前缺铁性贫血管理标准化方案还与入院分娩时血红蛋白升高有关（实施前：10.9；四分位距 [10.1-11.6] vs 实施后：11.0；四分位距 [10.3-11.7]，P=0.048）。两组之间在输血方面无显著差异（实施前：7.1% vs 实施后：5.1%，P=0.13）。
实施产前贫血标准化方案与静脉注射蔗糖铁的利用率增加和分娩前血红蛋白水平改善相关。
