目的本研究旨在评估和比较巴林镰状细胞病(SCD)妇女与健康孕妇的妊娠结局。目的是更新现有数据,以便提出实施多学科管理计划的战略,这将提高SCD患者人群的妊娠结局。材料和方法这项回顾性病例对照研究是在巴林SalmaniyaMedicalComplex(SMC)的妇产科进行的。研究组由所有在2019年1月1日至2021年12月31日期间在SMC分娩的纯合SCD(HbSS)孕妇组成。对照组包括在同一时期在SMC分娩但没有SCD或性状的孕妇。该研究的数据是从SMC的医疗保健系统记录中收集的,特别是I-Seha电子病历系统和劳动室登记簿。对数据进行了彻底的审查和分析,包括217例SCD和200例对照。检查的变量包括国籍,年龄,妊娠,奇偶校验,胎龄,入院原因,产前/产后并发症(如尿路感染,肺炎,急性胸部综合征,血栓栓塞,胎膜早破,高血压,先兆子痫,和宫内生长受限),交货类型,出生体重,新生儿结局,和产后并发症。结果与对照组相比,患有SCD的孕妇的产前住院率明显更高-69.6%至少两次入院,而只有16.5%。血管闭塞危象是超过一半的SCD患者入院的主要原因,22.6%有一集,11.1%有两个,20.3%的人在怀孕期间有两个以上。低血红蛋白水平也需要11.1%的SCD女性入院,虽然没有对照组需要住院治疗。SCD组的孕产妇发病率负担明显更大,仅20.3%无并发症,对照组为94%。SCD女性输血率升高,急性胸部综合征,和尿路感染.不良妊娠结局也更常见,包括更高的早产风险,低出生体重,和宫内生长受限.尽管这些增加了产妇和胎儿的风险,两组间高血压疾病的发生率无显著差异.有趣的是,我们的数据显示,与对照组相比,SCD组的妊娠期糖尿病发病率明显较低(8.3%vs.18%)。可悲的是,SCD组发生1例产妇死亡,尽管总体孕产妇死亡率没有显著差异.结论SCD对母亲和胎儿构成重大风险。与多学科团队的仔细监测和患者教育至关重要。早期发现可以降低发病率和死亡率。需要进一步研究干预措施以改善结果。
Objectives The study sought to evaluate and compare the maternal and fetal outcomes of pregnancy in women with sickle cell disease (SCD) versus healthy pregnant women in Bahrain. The objective was to update the available data in order to come up with a strategy to implement a multidisciplinary management program, which will enhance pregnancy outcomes for the SCD patient population. Materials and methods This retrospective case-control study was conducted in the Obstetrics and Gynecology Department at Salmaniya Medical Complex (SMC) in Bahrain. The study group consisted of all pregnant women with homozygous SCD (HbSS) who delivered at SMC between January 1, 2019, and December 31, 2021. The control group comprised pregnant women who delivered at SMC during the same period but did not have SCD or trait. Data for the study were collected from the healthcare system records at SMC, specifically the I-Seha electronic medical record system and the labor room registry book. A thorough review and analysis of the data were conducted, encompassing 217 cases of SCD and 200 controls. The variables examined included nationality, age, gravidity, parity, gestational age, reason for admission, antenatal/postnatal complications (such as urinary tract infection, pneumonia, acute chest syndrome, thromboembolism, premature rupture of membranes, hypertension, pre-eclampsia, and intrauterine growth restriction), type of delivery, birth weight, newborn outcome, and postnatal complications. Results Pregnant women with SCD experienced significantly higher rates of antenatal hospitalization compared to controls - 69.6% were admitted at least twice versus only 16.5%. Vaso-occlusive crises were the primary reason for admission in over half of SCD patients, with 22.6% having one episode, 11.1% having two, and 20.3% having more than two during pregnancy. Low hemoglobin levels also necessitated admission in 11.1% of SCD women, while no controls required hospitalization for this. The burden of maternal morbidity was substantially greater in the SCD group, with only 20.3% free of complications versus 94% in controls. SCD women had elevated rates of blood transfusions, acute chest syndrome, and urinary tract infections. Adverse pregnancy outcomes were also more common, including higher risks of preterm birth, low birth weight, and intrauterine growth restriction. Despite these increased maternal and fetal risks, there was no significant difference in the incidence of hypertensive disorders between groups. Interestingly, our data showed a significantly lower incidence of gestational diabetes in the SCD group compared to controls (8.3% vs. 18%). Tragically, one maternal death occurred in the SCD group, although the overall maternal mortality did not differ significantly. Conclusion SCD poses substantial risks for mother and fetus. Careful monitoring with a multidisciplinary team and patient education are crucial. Early detection can reduce morbidity and mortality. Further research is needed on interventions to improve outcomes.