109例妊娠期血小板减少的临床分析

 目的 探讨妊娠期发生血小板减少的病因、临床特征及其对母婴的影响，降低围生期母婴出血并发症的发生。方法 回顾性分析复旦大学附属妇产科医院2001年11月至2008年6月收治的109例妊娠期伴有血小板减少的孕产妇临床资料。结果 多数患者诊断为妊娠相关性血小板减少（pregnancy-associated thrombocytopenia，PAT），21例（19.3%）诊断为免疫性血小板减少性紫癜（idiopathic thrombocytopenic purpura，ITP），其中妊娠合并ITP 20例、妊娠合并Evans’综合征 1例；5例（4.6%）诊断为妊娠高血压综合征者，其中1例为先兆子。新生儿发生血小板减少者5例（5.9%）。分娩时出血量和血小板下降的程度无明显关联。结论 妊娠期出现血小板减少的病因有多种，以PAT和ITP最多见。既往有血小板减少、过敏、病毒感染、自身免疫性疾病等病史均是妊娠期发生血小板减少的高危因素。

Retrospective analysis on 109 cases of thrombocytopenia in pregnancy

Objective To investigate the causes, clinical features and influence on mother and infant of thrombocytopenia in pregnancy in order to decrease maternal-infant bleeding during perinatal period. Methods Clinical data of 109 cases of thrombocytopenia during pregnancy from Nov 2001 to Jun 2008 in Obstetrics & Gynecology Hospital were reviewed retrospectively. Results Pregnancy-associated thrombocytopenia (PAT) is the major cause of thrombocytopenia in pregnancy. Twenty-one cases (19.3%) were diagnosed as immune or idiopathic thrombocytopenia purpura (ITP), in those 20 cases were pregnancy in combination with ITP and one case was pregnancy in combination with Evans’ syndrome. Five cases (4.6%) were diagnosed as hypertensive disorders during pregnancy, one of which was severe pre-eclampsia. Five infants (5.9%) experienced thrombocytopenia. There was no relation between hemorrhage in childbirth and the severity of thrombocytopenia. Conclusions PAT and ITP lead to most thrombocytopenia in pregnancy. The risk factors include histories of thrombocytopenia, allergy, viral infection and autoimmune diseases.