妊娠合并特发性血小板减少性紫癜110例临床分析

目的:探讨妊娠合并特发性血小板减少性紫癜(idiopathic thromboeytopenic purpura,ITP)的诊断、治疗及其对母婴的影响.方法:回顾性分析1997年1月-2011年4月间住院分娩110例妊娠合并ITP患者的临床资料.结果:阴道分娩68例,剖宫产42例.其中发生产后出血3例,无死亡病例.予以单纯糖皮质激素治疗33例,糖皮质激素联合丙种球蛋白治疗25例,糖皮质激素联合丙种球蛋白治疗效果不佳或入院时血小板极低因产科因素需急诊剖宫产予以血小板悬液输注48例.除1例新生儿出生后外周血小板计数＜ 100×109/L外,其余均在正常水平(＞ 100×109/L),无颅内出血及其他血小板减少或相关疾病.结论:妊娠合并ITP时,若处理及时得当,对母婴影响很小.糖皮质激素联合丙种球蛋白为有效的治疗方法,分娩方式由产科情况决定,若无产科指征,以阴道分娩为宜;若治疗无效或血小板水平极低,也可在血源充足时行选择性剖宫产.

Clinical Analysis of 110 Cases of Pregnancy with Idiopathic Thrombocytopenic Purpura

Objective:To study the diagnosis and management of pregnant women with idiopathic thrombocytopenic purpura(ITP).Methods:The clinical data of preganacies with ITP from January 1997 to April 2011 were analysed.Results:Among the 110 cases,vaginal delivery and cesarean section were performed in 68(61.8%) and 42(38.2%) cases respectively.The incidence of postpartum hemorhage was 2.7%(3/110 cases).There was no maternal death.33,25 and 48 cases were treated by glucocorticoids,glucocorticoids plus gamma globulin,and transfusion of platelets,respectively.Except 1 case the platelet count of peripheral blood in newborns was less than 100×109/L.Others were high than 100×109/L.There were no intracranial hemorhage and other diseases related to platelet decrease Conclusions:ITP has very little direct effects on mother and fetus if receive timely treatment.Glucocorticoids,gamma globulin and transfusion of platelets are effective methods for the treatment of ITP in pregnancy.The mode of delivery is determined by obstetrical considerations.They should be delivered vaginally if there is no obstetrical complications.To severely thrombocytopenic cases,selected cesarean should be performed when there are sufficient fresh platelet.