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.     

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。     

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。     

妊娠期血小板减少93例临床探讨

目的:探讨妊娠期血小板减少(gestational thrombocytopenia,GT)对母儿的影响、处理以及分娩方式的选择。方法:回顾分析2005年1月至2006年6月93例GT患者的临床资料。结果:GT占妊娠合并血小板减少症的86.9%。血小板计数(31~50)×109/L 8例,占8.6%;(51~99)×109/L 85例,占91.4%。经糖皮质激素治疗3例,均在分娩前施行冲击治疗;4例在剖宫产时输注血小板。阴道分娩21例,剖宫产72例(产科因素剖宫产42例)。产后出血6例。新生儿血小板计数均正常。结论:妊娠期血小板减少母儿预后好,GT在妊娠期不需要治疗,血小板计数<50×109/L者在临近分娩前最好进行激素冲击治疗;GT患者不一定输注血小板。除非伴有临床出血症状,GT孕妇应以产科指征决定分娩方式。     

妊娠期血小板减少程度对母儿结局的影响

目的 比较妊娠期不同程度血小板减少对母儿结局的影响.方法 回顾性分析2000年1月1日至2010年1月31日本院收治的妊娠期血小板减少病例305例,病因学诊断分别为妊娠期血小板减少症、特发性血小板减少性紫癜及部分病因不明者.根据孕期最低血小板计数分成4组:I组:(50～100) ×109/L;Ⅱ组:(30～50)×109/L;Ⅳ组:(10～30)×109/L;Ⅳ组:＜10×109/L.Ⅰ～Ⅳ组病例数依次为101、85、87和32例.比较各组患者孕期并发症、治疗、新生儿结局和随访情况.应用SPSS 17.0统计软件进行数据处理,采用方差分析、Spearman等级相关分析、卡方检验、趋势卡方分析.结果 305例孕妇并发贫血68例(22.30%),早产40例(13.11%),产后出血60例(19.67%),患病率均随血小板减少程度加重而升高(P均＜0.05),产后24 h内出血量随血小板减少程度加重而增多.孕期并发妊娠期高血压疾病35例(11.48%),糖代谢异常23例(7.54%),各组患病率差异均无统计学意义.产褥感染2例(0.66%),无孕产妇死亡.305例产妇随访血小板恢复者共211例(69.18%),产后半年内母体血小板恢复正常率Ⅰ～Ⅳ组依次为90.59%(77/85)、82.36%(42/51)、46.16%(24/52)和39.13%(9/23),随孕期血小板减少程度加重而恢复率下降(x2趋势=42.616,P趋势=0.000).活产儿301例,胎死宫内5例,早期新生儿死亡4例,新生儿血小板减少18例(5.98%),颅内出血1例.随母体血小板减少程度加重,新生儿血小板减少患病率增高(x2趋势=17.806,P趋势=0.000);16例新生儿血小板减少在出生后3～8周恢复正常,2例随访3年未恢复.结论 随着血小板减少程度加重,母体贫血、早产、产后出血及新生儿血小板减少的患病风险均有增加.严密的围产期保健可改善不同程度血小板减少患者的母儿结局.

Abstract：

Objective To investigate the perinatal outcomes of pregnancies complicated with varying degrees of thrombocytopenia.Methods Clinical data of 305 pregnant women with thrombocytopenia,who admitted to Peking University People's Hospital from January 1,2000 to January 31,2010 were retrospectively analyzed.The etiological diagnosis of them were gestational thrombocytopenia (GT),idiopathic thrombocytopenic purpura (ITP) or undetermined.The patients were divided into 4 groups according to the minimal level of platelets in pregnancy ( platelets count was lower than 100 ×109/L at least twice) : groupⅠ,(50-100) ×109/L (n=101) ; group Ⅱ,(30-50) × 109/L (n = 85); group Ⅲ,(10-30) × 109/L (n = 87); group Ⅳ,< 10 × 109/L (n = 32).Demographic data such as pregnancy complications,treatment,neonates and follow-up results of the patients in each group were compared with ANOVA,Spearman rank correlation analysis,Chirsquare test and Chi-square trend test in SPSS 17.0.Results Medical complications in pregnancy of these patients included hypertensive disorder complicating (n = 35,11.48%) and abnormal glucose metabolism (n=23,7.54%),no difference was found in the incidence of these diseases among the four groups.There were 68 patients complicated with anemia (22.30%),40 preterm delivery (13.11%),60 postpartum hemorrhage (19.67%); there were significant differences in the incidence among the four groups (P＜0.05),the incidence increased with the aggravation of thrombocytopenia (P＜0.05).There were 2 cases of puerperal infection (0.66%),no maternal deaths.Fifty-one patients (16.72%) accepted treatment of corticosteroids or Gamma globulin during pregnancy.There were 116 cases (38.03%) of vaginal delivery and 189 cases (61.97%) of cesarean section.The postpartum bleeding amount within 24 hours increased with the aggravation of thrombocytopenia.Two hundred and eleven (69.18%) patients were followed up and platelet count regained normal,among which 152 cases recovered within six months after delivery.The recovery rates were 90.59% (77/85),82.36% (42/51),46.16% (24/52) and 39.13% (9/23) from group Ⅰ to group Ⅳ,as declined with the aggravation of thrombocytopenia in pregnancy ( x2trend = 42.616,Ptrend =0.000).Among the 306 perinatal fetuses,neonatal outcomes included 301 live births,5 fetal deaths,4 early neonatal deaths,4 low birth-weight infants after term birth,1 intracranial hemorrhage and 18 (5.98%) neonatal thrombocytopenia cases.Incidence of neonatal thrombocytopenia increased with the aggravation of maternal thrombocytopenia.Sixteen cases of neonatal thrombocytopenia recovered at 3-8 weeks after birth,but two cases did not recover within three years during followed up.Conclusions The perinatal outcomes are different in pregnancies complicated with varying degrees of thrombocytopenia.As thrombocytopenia in pregnancy become worse,the risk of anemia,premature delivery,postpartum hemorrhage and neonatal thrombocytopenia increases.While,perinatal outcomes may be better under close perinatal care.     

妊娠合并恶性肿瘤14例临床分析

目的探讨妊娠合并恶性肿瘤患者的临床特点及母儿结局。 方法收集2009年10月至2015年12月就诊于广州医科大学附属第三医院妇产科的14例妊娠合并恶性肿瘤患者的临床资料,对患者的临床特点、孕期治疗、妊娠结局及预后进行分析。 结果14例妊娠合并恶性肿瘤患者的肿瘤类型分别为血液系统恶性肿瘤(8例)、乳腺癌(4例)和宫颈癌(2例)。足月分娩者有5例,早产6例,1例早期人工流产,1例中孕期引产,1例孕期死亡。共分娩新生儿11例,2例乳腺癌患者于孕期接受抗癌治疗,2例新生儿为足月儿;10例患者孕期选择期待治疗,9例患者的新生儿存活,包括3例足月儿和6例早产儿。 结论妊娠合并恶性肿瘤可导致严重的不良妊娠结局,根据病情孕期应进行合理的抗癌治疗可改善患者结局。     

妊娠合并系统性红斑狼疮的临床研究

目的探讨妊娠合并系统性红斑狼疮对母婴结局的影响。 方法回顾性分析广州医学院第三附属医院2005年1月至2009年12月近5年收治的34例妊娠合并系统性红斑狼疮患者的临床资料。在医师指导下妊娠,为选择性妊娠组(14例);未在医师指导下妊娠,为非选择性妊娠组(20例),分析比较两组患者分娩孕周及母婴结局。连续变量补体C3、C4进行独立样本t检验。两组率的比较采用Fisher确切概率检验。 结果选择性妊娠组14例中11例病情平稳,足月分娩6例,早产6例,平均分娩孕周为(35.3±4.3)周,新生儿出生体质量(2076.9±192.4) g;非选择性妊娠组20例中12例出现系统性红斑狼疮活动,足月分娩4例,早产6例,平均分娩孕周为(33.6±4.2)周,新生儿出生体质量(1315.0±488.5) g;选择性妊娠的妊娠成功率86%,明显高于非选择性妊娠组的50% (P＝0.035)。 结论妊娠合并系统性红斑狼疮系高危妊娠,存在较高的母婴风险。非选择性妊娠有更多的胎儿丢失率,选择性妊娠和孕期多学科协作可显著改善妊娠结局。     

妊娠期血小板减少76例临床分析

目的　探讨妊娠期血小板减少的原因及临床处理对策。方法　回顾性分析汕头大学医学院第一附属医院 1 993～ 2 0 0 3年间 76例妊娠合并血小板减少患者临床资料。结果　妊娠期血小板减少的患者中 ,72 3%为妊娠期血小板减少症 (gestationalthrombocytopenia ,GT) ,1 4 5 %为妊娠高血压综合征 (PIH) ,特发性血小板减少性紫癜 (ITP)占 9 2 %。其中GT组不需要特别处理 ,PIH组以皮质激素及输血小板为主 ,ITP组以皮质激素或免疫球蛋白 (IVIG)为主。血小板低于 2 0× 1 0 9/L时输注血小板。全部病例无孕产妇死亡及新生儿血小板减少。结论　妊娠期血小板减少原因较多 ,应依据不同病情进行不同处理