113例妊娠合并血小板减少临床分析

目的:讨论妊娠合并血小板减少的原因,处理及预后。方法:回顾性分析我院2009年～2011年收治的113例妊娠合并血小板减少患者的临床资料。结果:妊娠合并血小板减少的原因最常见的是妊娠相关性血小板减少(PAT),其次为妊娠期高血压疾病及免疫性血小板减少性(ITP)。分娩方式由产科指征决定。113例患者均预后良好。结论:对于妊娠合并血小板减少应明确病因,针对病因、血小板减少的程度及有无症状,采取不同的处理方法。血小板减少绝大多数均可在较短时间内恢复正常,结局较好。     

妊娠合并极重度血小板减少26例临床分析

目的 探讨妊娠合并极重度血小板减少患者的病因诊断、临床处理及妊娠结局.方法 回顾性分析2004年1月到2009年3月在北京大学人民医院产科分娩的26例妊娠合并极重度血小板减少患者的临床资料.以孕期至少有2次或2次以上血小板计数<10×109/L为极重度血小板减少诊断标准.进行病因诊断,根据不同病因给予以下临床处理.(1)孕期在无全身自发性出血情况下,维持血小板计数>20×109/L,血红蛋白>70 g/L;(2)血小板<10×109/L或有出血倾向时,输注血小板;红细胞压积(HCT)<25%,血红蛋白<70 g/L时,输注压积红细胞;(3)剖宫产术前或分娩前维持血红蛋白>70 g/L,血小板计数>30×109/L;(4)特发性血小板减少性紫癜(ITP)患者血小板<(20～30)×109/L或有出血倾向时,用泼尼松或联合丙种球蛋白治疗.对于上述治疗无效者,若血小板<10×109/L或有出血倾向时间断输注血小板,无出血倾向者根据孕周严密观察,适时终止妊娠.对患者的一般临床资料、病因诊断、临床处理及妊娠结局进行分析.结果 (1)发病率及发病原因:同期分娩数为9302例,妊娠合并极重度血小板减少患者26例,妊娠合并极重度血小板减少的发生率为0.28%.患者年龄平均29岁.孕前诊断17例,孕期诊断9例.26例患者中,有13例在我院行系统产前检查,初次诊断极重度血小板减少时的平均孕周为24周;无系统产前检查的13例,初次诊断极重度血小板减少时的平均孕周为32周.26例患者中,2例(8%,2/26)病因诊断不明,24例(92%,24/26)病因诊断明确,其中14例(54%,14/26)为ITP,5例为骨髓增生异常综合征(MDS),4例为慢性再生障碍性贫血(CAA),1例为系统性红斑狼疮(SLE).(2)临床处理:所有患者均多次应用血制品.14例ITP患者中6例应用了泼尼松+丙种球蛋白治疗,8例仅应用泼尼松治疗.26例患者中有9例(35%,9/26)出现了妊娠并发症,其中6例(6/9)并发子痫前期,2例发生妊娠期糖尿病,1例为弥漫性肺泡出血.26例患者平均分娩孕周为36周,阴道分娩3例,平均出血量为83 ml;23例剖宫产分娩,平均出血量为410 ml.(3)围产儿结局:26例围产儿中,1例胎死宫内,25例活婴,其中12例为早产儿.平均孕龄36周,平均出生体质量2877 g.2例ITP患者分娩的新生儿出现了重度血小板减少.结论 妊娠合并极重度血小板减少的主要病因是ITP,治疗以泼尼松+丙种球蛋白为主;其次是CAA和MDS,以支持疗法为主.妊娠合并极重度血小板减少并非终止妊娠的绝对指征,可根据不同病因予相应治疗后,在严密的围产期监测下,注意防治妊娠并发症,分娩方式以剖宫产为主,可获得较好的妊娠结局.     

妊娠合并极重度血小板减少26例临床分析

Objective To investigate the etiology and perinatal outcome of pregnancies complicated with extremely severe thrombocytopenia [ at least two times of platelets count (PLT) < 10 × 109/L during pregnancy]. Methods Clinical data, including basic information, etiology, management and outcomes of pregnant women with extremely severe thrombocytopenia, admitted to Peking University People's Hospital from January 2004 to March 2009, were retrospectively collected. The management of these cases varied according to different etiology and the symptoms: (1) PLT were maitained > 20 × 109/L and hemoglobulin> 70 g/L in those women without spontaneous bleeding; (2) PLT transfusion would be required when PLT< 10 × 109/L or bleeding occur and RBC would be supplied when hematocrit <25% and hemoglobulin <70g/L; (3) Hemoglobulin should be > 70 g/L and PLT >30 × 109/L before cesarean section or delivery;(4) Predinisone and/or intravenous immunoglobulin G (IVIG) would be given in women complicated with idiopathic thrombocytopenic purpura (ITP) when PLT < (20-30) × 109/L or bleeding. PLT would be given if all the above management were failed, or PLT < 10 × 109/L, or bleeding. Women without bleeding would be closely monitored and delivery would be planned. Results (1) Twenty-six cases were identified among 9302 deliveries during the study period (0.28%), with an average of maternal age of 29. Seventeen were diagnosed before conception and 9 during pregnancy. Among the 26 women, half received regular prenatal check in our hospital and the average gestations at diagnosis was 24 weeks and the other half without regular prenatal visits and the average gestations at diagnosis was 32 weeks. Etiology was identified in 24 out of the 26 women, including 14(54%) ITP, 5 myelodysplastic syndrome (MDS), 4 chronic aplastic anaemia(CAA) and 1 systemic lupus erythematosus (SLE). (2) Management: All of the 26 women received blood products. Among the 14 ITP cases, 6 received predinisone and IVIG and 8 only took predinisone. Nine of the 26 patients (35%) had pregnant complications, among which 6 (6/9) were preeclampsia. The overall average gestation at delivery was 36 weeks. Only 2 delivered vaginally with the average blood loss of 83 ml and 23 cesarean sections were performed with the average blood loss of 410 ml. (3) Perinatal outcomes:There were 26 perinatal babies, among which 1 died intrauterine and 25 were born alive (12 preterm infants). The average birth weight was 2877 g. Neonatal severe thrombocytopenia presented in 2 newborns whose mother complicated with ITP. Conclusions The main cause of extremely severe thrombocytopenia during pregnancy is ITP, managed mainly by predinisone and IVIG, followed by CAA and MDS, which may require supportive treatment. Pregnancy complicated with extremely severe thrombocytopenia is not an indication of termination. Better maternal and fetal outcomes can be achieved through proper treatment based on the etiology, intensive care in prevention and management of complications and cesarean section.     

妊娠合并极重度血小板减少26例临床分析

Objective To investigate the etiology and perinatal outcome of pregnancies complicated with extremely severe thrombocytopenia [ at least two times of platelets count (PLT) < 10 × 109/L during pregnancy]. Methods Clinical data, including basic information, etiology, management and outcomes of pregnant women with extremely severe thrombocytopenia, admitted to Peking University People's Hospital from January 2004 to March 2009, were retrospectively collected. The management of these cases varied according to different etiology and the symptoms: (1) PLT were maitained > 20 × 109/L and hemoglobulin> 70 g/L in those women without spontaneous bleeding; (2) PLT transfusion would be required when PLT< 10 × 109/L or bleeding occur and RBC would be supplied when hematocrit <25% and hemoglobulin <70g/L; (3) Hemoglobulin should be > 70 g/L and PLT >30 × 109/L before cesarean section or delivery;(4) Predinisone and/or intravenous immunoglobulin G (IVIG) would be given in women complicated with idiopathic thrombocytopenic purpura (ITP) when PLT < (20-30) × 109/L or bleeding. PLT would be given if all the above management were failed, or PLT < 10 × 109/L, or bleeding. Women without bleeding would be closely monitored and delivery would be planned. Results (1) Twenty-six cases were identified among 9302 deliveries during the study period (0.28%), with an average of maternal age of 29. Seventeen were diagnosed before conception and 9 during pregnancy. Among the 26 women, half received regular prenatal check in our hospital and the average gestations at diagnosis was 24 weeks and the other half without regular prenatal visits and the average gestations at diagnosis was 32 weeks. Etiology was identified in 24 out of the 26 women, including 14(54%) ITP, 5 myelodysplastic syndrome (MDS), 4 chronic aplastic anaemia(CAA) and 1 systemic lupus erythematosus (SLE). (2) Management: All of the 26 women received blood products. Among the 14 ITP cases, 6 received predinisone and IVIG and 8 only took predinisone. Nine of the 26 patients (35%) had pregnant complications, among which 6 (6/9) were preeclampsia. The overall average gestation at delivery was 36 weeks. Only 2 delivered vaginally with the average blood loss of 83 ml and 23 cesarean sections were performed with the average blood loss of 410 ml. (3) Perinatal outcomes:There were 26 perinatal babies, among which 1 died intrauterine and 25 were born alive (12 preterm infants). The average birth weight was 2877 g. Neonatal severe thrombocytopenia presented in 2 newborns whose mother complicated with ITP. Conclusions The main cause of extremely severe thrombocytopenia during pregnancy is ITP, managed mainly by predinisone and IVIG, followed by CAA and MDS, which may require supportive treatment. Pregnancy complicated with extremely severe thrombocytopenia is not an indication of termination. Better maternal and fetal outcomes can be achieved through proper treatment based on the etiology, intensive care in prevention and management of complications and cesarean section.     

妊娠合并血小板减少112例临床分析

目的:探讨妊娠合并血小板减少的发病机制及围生期的处理方法。方法:回顾分析天津医科大学总医院1992年至2002年间112例妊娠合并血小板减少患者的病因及临床处理经验。结果:112例孕妇中特发性血小板减少性紫癜27例,占24.1%;子痫前期44例,占39.3%;妊娠期特发性血小板减少40例,占34.8%;血栓性血小板减少性紫癜1例,占0.89%。阴道分娩27例,剖宫产85例。产后出血13例,产褥感染1例。结论:多种原因可以导致妊娠妇女血小板减少。如无产科指征,以阴道分娩为宜;血小板<50×109/L时,在血源充足时行剖宫产。不主张采用侵入性检查方法确定胎儿血小板水平。     

妊娠合并血小板减少61例临床分析

目的 :探讨妊娠合并血小板减少的病因和围产期的处理方法。方法 :回顾分析 6 1例妊娠合并血小板减少患者的临床资料。结果 :6 1例血小板减少的病因为再生障碍性贫血、特发性血小板减少性紫癜 (ITP)、脾功能亢进、系统性红斑狼疮 (SLE)、抗心磷脂抗体综合征、妊娠高血压综合征及妊娠期肝内胆汁淤积症 (ICP)。治疗方法是使用糖皮质激素、免疫球蛋白与成分输血等。早产 15例 ,阴道分娩 10例 ,剖宫产 5 1例。结论 :妊娠合并血小板减少处理的重点是治疗合并症和并发症 ,加强监护 ,适时提升血小板数 ,防止分娩期出血     

妊娠合并血小板减少108例临床分析

目的探讨妊娠合并血小板减少的原因及围生期处理。方法1995-2005对南通大学附属医院收治的108例妊娠合并血小板减少患者的临床资料进行回顾性分析。结果妊娠合并血小板减少的主要原因有妊娠相关性血小板减少(PAT),特发性血小板减少性紫癜(ITP)和妊娠期高血压疾病。PAT一般不需特殊处理。血小板<50×109/L,或有明显出血倾向时,给予糖皮质激素或(和)免疫球蛋白治疗;输注血小板只用于血小板<50×109/L,且有明显出血倾向,或紧急手术前。分娩方式视血小板多少及有无产科指征而定。结论妊娠合并血小板减少应视不同的病因、血小板减少的轻重程度以及病情的缓急状况,而采取不同的处理方式。     

妊娠合并血小板减少208例临床分析

目的:探讨妊娠合并血小板减少的病因及围生期的处理方法。方法:回顾性分析1996年1月至2005年12月收治的妊娠合并血小板减少患者208例临床资料。结果:208例孕妇中妊娠期血小板减少症(PAT)88例(42.31%),特发性血小板减少性紫癜(ITP)58例(27.88%),妊娠期高血压疾病32例(15.38%),系统性红斑狼疮12例(5.77%),再生障碍性贫血(AA)10例(4.81%),妊娠期肝内胆汁淤积症(ICP)2例(0.96%),血栓性血小板减少性紫癜(TTP)2例(0.96%),Evan’s综合征1例(0.48%),病因不明3例(1.44%)。结论:多种原因可引起妊娠期孕妇血小板减少,PAT是最常见类型。血小板<50×109/L,应在术前输注浓缩血小板后行剖宫产;血小板计数>50×109/L的孕妇,如无产科指征,应阴道分娩为主。     

妊娠合并原发性血小板减少性紫癜30例分析

妊娠合并原发性血小板减少性紫癜３０例分析王桂荣，刘映粦（天津医学院第二附属医院）原发性血小板减少性紫癜（ＩＴＰ）是一种常见的出血性疾病，好发于年轻妇女，但妊娠伴发ＩＴＰ者少见。１９８０～１９９０年我科共收治３０例，现报告如下。１临床资料１．１一股资料...     

妊娠期血小板减少59例临床分析

血小板减少是妊娠期常见的并发症,近年发病率有增高趋势.我们回顾分析了我院妊娠期血小板减少(gestation thrombopeny,GT)59例的临床资料,探讨妊娠期血小板减少的临床特征和处理方法,正确评价妊娠期血小板减少患者的母儿风险,以避免不必要的干预和治疗.     

妊娠合并血小板减少症35例临床分析

目的 :探讨妊娠合并血小板减少症 (PT)的病因及处理。方法 :回顾性分析 35例PT患者的诊断、治疗及新生儿结局。结果 :PT的病因主要包括妊娠相关性血小板减少症 (PAT)、免疫性血小板减少性紫癜 (ITP)及妊高征 /先兆子痫 /HELLP综合征。对血小板计数 <5 0× 10 9/L者在分娩前后应短期使用糖皮质激素及血小板制剂 ,分娩方式应由产科指征决定。产后出血率为 14 .2 8% ,产后出血量与血小板计数呈负相关 ,未发现新生儿出血。PAT患者在分娩后 2月内血小板计数恢复正常。结论 :PAT是最常见的妊娠合并血小板减少症类型 ,产时对母儿无明显危害。除了针对病因治疗外 ,糖皮质激素及血小板制剂是治疗严重PT的有效手段。     

108例妊娠合并血小板减少临床分析

目的:分析妊娠合并血小板减少(PT)的临床特点与围生期处理。方法:对108例妊娠合并血小板减少患者的临床资料作回顾性研究。结果108例患者中妊娠相关性血小板减少(PAT)占94例(87.9%),妊娠期肝内胆汁淤积症(ICP)3例(2.8%),妊娠高血压疾病(HDCP)2例(1.8%),特发性血小板减少性紫癜(ITP)5例(4.6%),其他病因2例(1.8%)。有出血倾向或血小板计数<50*109/L患者需用糖皮质激素和(或)免疫球蛋白治疗,阴道分娩9例,剖宫产93例,产后出血8例,死亡1例。结论:PAT是PT的最主要病因,糖皮质激素、丙种球蛋白,血小板输注是治疗PT的有效手段,分娩方式视血小板多少及有无产科手术指征而决定,大部分以剖宫产终止妊娠。     

108例妊娠合并血小板减少临床分析

目的:分析妊娠合并血小板减少(PT)的临床特点与围生期处理。方法:对108例妊娠合并血小板减少患者的临床资料作回顾性研究。结果108例患者中妊娠相关性血小板减少(PAT)占94例(87.9%),妊娠期肝内胆汁淤积症(ICP)3例(2.8%),妊娠高血压疾病(HDCP)2例(1.8%),特发性血小板减少性紫癜(ITP)5例(4.6%),其他病因2例(1.8%)。有出血倾向或血小板计数<50*109/L患者需用糖皮质激素和(或)免疫球蛋白治疗,阴道分娩9例,剖宫产93例,产后出血8例,死亡1例。结论:PAT是PT的最主要病因,糖皮质激素、丙种球蛋白,血小板输注是治疗PT的有效手段,分娩方式视血小板多少及有无产科手术指征而决定,大部分以剖宫产终止妊娠。     

妊娠合并血小板减少98例临床分析

目的　探讨妊娠合并血小板减少的病因及围生期处理方法。方法　总结 1994～ 2 0 0 3年间 98例妊娠合并血小板减少患者的临床资料。结果　妊娠合并血小板减少的主要原因包括妊娠相关性血小板减少症(PAT) ,特发性血小板减少性紫癜 (ITP)和妊娠期高血压疾病 (妊高征 )。治疗方法为在治疗原发病的基础上 ,对血小板计数 <5 0× 10 9/L者于分娩前后短期使用糖皮质激素及血小板制剂。 98例中阴道分娩 34例 ,剖宫产 6 4例 ;发生产后出血 12例 ,产后出血发生率为 12 2 % ;胎死宫内 3例。新生儿血小板减少 7例。结论　在针对病因治疗的基础上 ,糖皮质激素及血小板制剂是治疗严重妊娠合并血小板减少的有效手段。     

妊娠相关性血小板减少84例临床分析

妊娠相关性血小板减少(pregnancy associated thrombocy-topenia,PAT)临床上较常见,近年发病率有增高趋势.现回顾分析妊娠相关性血小板减少84例患者的临床资料,探讨PAT的临床特征、处理及对妊娠结局的影响,以避免不必要的干预和治疗.     

妊娠合并原发免疫性血小板减少症44例临床分析

目的:探讨妊娠合并原发免疫性血小板减少症(ITP)患者的围产期诊疗及母儿结局。方法:选取2015年至2021年在山东大学齐鲁医院妇产科分娩的妊娠合并ITP(血小板计数<30×10⁹/L)孕妇44例,其中重症ITP 21例。观察患者在围产期的诊疗及母儿结局。结果:医院同期分娩总数为27268例,妊娠合并ITP 44例,发生率为1.6‰。44例患者中有7例为终止妊娠前转入我院,未行药物治疗,27例(61.4%)孕期单独给予糖皮质激素治疗,10例(22.7%)给予糖皮质激素联合丙种球蛋白治疗。阴道分娩4例(9.1%),剖宫产终止妊娠40例(90.9%),产后出血2例(4.5%)。44例新生儿出生后血小板计数<100×10⁹/L者3例(6.8%),无新生儿颅内出血及死亡病例。两组的围产期输注血小板治疗量、出血量、新生儿体重、新生儿5min Apgar评分比较,差异均无统计学意义(P>0.05),住院天数和新生儿1min Apgar评分比较差异有统计学意义(P<0.05)。结论:妊娠合并ITP的治疗以糖皮质激素与丙种球蛋白为主,...     

妊娠合并血小板减少426例临床用血分析

目的:研究合并血小板减少孕妇在分娩时的用血情况及相关影响因素,为临床备血提供指导。方法:回顾分析山东大学齐鲁医院2016年1月至2019年6月收治的426例合并血小板减少孕妇的临床资料,根据血小板减少的轻重程度将其分为4组：Ⅰ组,血小板计数(101～125)×10⁹/L,115例;Ⅱ组,血小板计数(51～100)×10⁹/L,158例;Ⅲ组,血小板计数(21～50)×10⁹/L,108例;Ⅳ组,血小板计数≤20×10⁹/L,45例。分析4组孕妇的分娩方式及出血用血情况。结果:426例合并血小板减少孕妇中,50例(11.74%)选择经阴分娩,376例(88.26%)选择剖宫产结束分娩。4组的分娩方式比较,差异有统计学意义(P<0.05)。426例病例中有360例(84.50%)出血量低于1000mL;356例(83.57%)在分娩过程中输注了红细胞、血小板或其他血制品。出血量低于1000mL时,4组的出血量比较差异有统计学意义,Ⅰ组的出血量明显高于其他3组(P<0.05);Ⅳ组的输注红细胞...