Department of Obstetrics & Gynaecology, Ballarat Health Services, Ballarat, Victoria, Australia.
Department of Obstetrics & Gynaecology, Monash University, Clayton, Victoria, Australia.
Aust J Rural Health. 2023 Aug;31(4):744-757. doi: 10.1111/ajr.13002. Epub 2023 Jun 4.
Current Australian guidelines differ in their recommendations on optimal iron deficiency anaemia screening and management during pregnancy. A more active approach to screening and treatment of iron deficiency in pregnancy has been beneficial within a tertiary population. However, this approach has not been evaluated within a regional healthcare setting.
To evaluate the clinical impact of standardised screening and management for iron deficiency in pregnancy within a regional Australian centre.
Single centre, retrospective cohort observational study that audited medical records pre and post implementation of standardised screening and management for antenatal iron deficiency. We compared rates of anaemia at birth, rates of peripartum blood transfusions and rates of peripartum iron infusions.
There were 2773 participants with 1372 participants in the pre-implementation group and 1401 in the post-implementation group. Participant demographics were similar. Anaemia at admission for birth decreased from 35% to 30% (RR 0.87, 95% CI (0.75, 1.00), p 0.043) Fewer blood transfusions were required (16 (1.2%) pre-implementation, 6 (0.4%) post-implementation, RR 0.40, 95% CI(0.16, 0.99), p 0.048). Antenatal iron infusions increased from 12% to 18% of participants post implementation (RR 1.47, 95% CI(1.22, 1.76), p 〈0.001).We audited compliance with the guidelines and found improvements post implementation.
This is the first study to show clinically useful and statistically significant reduction in rates of anaemia and blood transfusions, post implementation of routine ferritin screening and management within a regional Australian population.
The results of this study suggest there is benefit to implementation of standardised ferritin screening and management packages in Australian antenatal care. It also encourages RANZCOG to review current recommendations on screening for iron deficiency anaemia during pregnancy.
目前澳大利亚的指南在妊娠期间缺铁性贫血筛查和管理的建议上存在差异。在三级人群中，更积极的筛查和治疗妊娠缺铁症是有益的。然而，这种方法尚未在区域医疗保健环境中进行评估。
评估在澳大利亚一个地区中心实施标准化妊娠缺铁筛查和管理对临床的影响。
单中心回顾性队列观察研究，对实施标准化产前缺铁筛查和管理前后的医疗记录进行审核。我们比较了出生时贫血的发生率、围产期输血的发生率和围产期铁输注的发生率。
共有 2773 名参与者，其中 1372 名在实施前组，1401 名在实施后组。参与者的人口统计学特征相似。入院分娩时的贫血率从 35%降至 30%（RR 0.87，95%CI（0.75，1.00），p=0.043），需要输血的人数减少（实施前 16 例[1.2%]，实施后 6 例[0.4%]，RR 0.40，95%CI（0.16，0.99），p=0.048）。产前铁输注从实施前的 12%增加到实施后的 18%（RR 1.47，95%CI（1.22，1.76），p 〈0.001）。我们审核了指南的遵守情况，并发现实施后有所改善。
这是第一项研究，表明在澳大利亚地区人群中，常规铁蛋白筛查和管理实施后，贫血和输血的发生率显著降低。
本研究结果表明，在澳大利亚产前护理中实施标准化铁蛋白筛查和管理方案是有益的。它还鼓励 RANZCOG 重新审查当前关于妊娠缺铁性贫血筛查的建议。
