TROPICAL OBSTETRICS AND GYNECOLOGY .1. ANEMIA IN PREGNANCY IN TROPICAL AFRICA
TROPICAL OBSTETRICS AND GYNECOLOGY .1. ANEMIA IN PREGNANCY IN TROPICAL AFRICA
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DOI：
10.1016/0035-9203(89)90241-1
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发表时间：
1989-07-01
影响因子：
2.2
通讯作者：
FLEMING, AF
中科院分区：
文献类型：
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作者：
FLEMING, AF
热带非洲孕妇贫血的主要原因是疟疾、缺铁、叶酸缺乏和血红蛋白疾病：现在还增加了获得性免疫缺陷综合症(艾滋病)。贫血往往是多因素的，不同的原因相互作用，形成免疫力低下、感染和营养不良的恶性循环。贫血经过3个阶段：代偿，仅在运动时呼吸困难；失代偿，休息时呼吸困难，血红蛋白(Hb)低于约70克/升；心力衰竭，Hb低于约40克/升。如果不进行治疗，一半以上患有红细胞压积和心力衰竭的女性会死亡。产妇贫血、疟疾以及铁和叶酸缺乏会导致胎儿宫内发育迟缓、早产，严重时还会导致围产儿死亡。存活下来的婴儿出生体重低，免疫缺陷，铁和叶酸储备不足。他们已经进入了感染、营养不良和免疫力受损的恶性循环。由于艾滋病的出现，输血治疗更加危险，应该仅限于挽救母亲的生命。疟疾的治疗很复杂，因为现在对氯喹有抗药性的菌株很常见。使用普罗瓜尼以及补充铁和叶酸进行预防仍然相对容易，而且在改善孕产妇和婴儿健康方面具有极高的成本效益；它比以往任何时候都更加重要，因为它避免了妇女和婴儿不必要地接触通过输血传播的艾滋病毒。
Major causes of anaemia in pregnancy in tropical Africa are malaria, iron deficiency, folate deficiency and haemoglobinopathies: now there is added also the acquired immune deficiency syndrome (AIDS). Anaemia is often multifactorial, with the different causes interacting in a vicious cycle of depressed immunity, infection and malnutrition. Anaemia progresses through 3 stages: compensation, with breathlessness on exertion only; decompensation, with breathlessness at rest and haemoglobin (Hb) below about 70 g/litre; cardiac failure, with Hb below about 40 g/litre. Without treatment, over half of the women with haematocrit <0·13 and heart failure die. Maternal anaemia, malaria and deficiencies of iron and folate cause intrauterine growth retardation, premature delivery and, when severe, perinatal mortality. Surviving infants have low birthweights, immune deficiency and poor reserves of iron and folate. They have entered already the vicious cycle of infection, malnutrition and impaired immunity. Treatment with blood transfusions is even more hazardous since the advent of AIDS, and should be limited to saving the life of the mother. Treatment of malaria is complex as chloroquine-resistant strains are now common. Prevention remains relatively easy with proguanil and supplements of iron and folic acid and is highly cost-effective in the improvement of maternal and infant health; it is more important than ever as it avoids the unnecessary exposure of women and infants to HIV transmitted through blood transfusion.