妊娠合并中重度血小板减少60例临床分析

目的探讨妊娠合并中重度血小板减少的病因、处理方法、分娩方式及新生儿情况。方法回顾性分析60例妊娠合并中重度血小板减少症患者的临床资料。结果妊娠合并中重度血小板减少的主要原因是特发性血小板减少症（ITP)25例(41.7%)；其次为妊娠期血小板减少症（GT)20例(33.3%)。糖皮质激素治疗有效率为72.7%，地塞米松+丙种球蛋白全部治疗有效，血小板输注有效率达75%。3种方法治疗前后血小板计数差别有统计学意义（P<0.01)。41例行剖宫产，19例阴道分娩。4例出现产后出血，均存在宫缩乏力，Spearman相关分析剖宫产病例的产后出血与治疗后的血小板计数之间存在负相关（r=-0.376，P=0.015）。新生儿4例出现血小板减少，其母亲均为ITP，2例有脾切除史的新生儿血小板均＜10×109L-1，1例新生儿出现消化道出血及颅内出血。结论妊娠合并中重度血小板减少以ITP及GT为主。糖皮质激素、丙种球蛋白和血小板制剂是治疗的有效手段。治疗后血小板＜50×109L-1或有产科指征行剖宫产，应有良好的宫缩来预防产后出血。治疗对剖宫产术中出血有一定的预防作用。ITP孕妇分娩的新生儿应监测血小板。对于有脾切除史的孕妇应充分告知发生严重新生儿血小板减少的风险及新生儿颅内出血的可能。

The Clinical Analysis of 60 Cases of Pregnancy with Moderate-to-Severe Thombocytopenia

ObjectiveTo explore the causes, treatment, mode of delivery and neonatal situation about pregnancy with moderate-to-severe thrombocytopenia.Methods60 cases of pregnancy with moderate-to-severe thrombocytopenia were retrospectively analyzed.ResultsThe main cause of pregnancy with moderate-to-severe thrombocytopenia is idiopathic thrombocytopenia (ITP) 25 cases, for 41.7%; followed by gestational thrombocytopenia (GT) 20 cases, for 33.3%.The effectiveness of dexamethasone, dexamethasone + immunoglobulin and platelet transfusion respectively is 72.2%, 100%, 75%.There was significant diference of platelet count before and after different treatments (P<0.01).41 cases cesarean section, 19 cases vaginal delivery, postpartum hemorrhage 4 cases, there are all esist uterine atony.Analyze by Spearman correlation.There is a negative correlation between postpartum hemorrhage of cesarean cases and the platelet count after treatment(r=-0.376, P=0.015).Neonatal thrombocytopenia in 4 cases, mothers are the ITP, mother has a history of splenectomy in 2 cases and neonatal platelets are less than 10×109L-1, neonatal gastrointestinal bleeding and intracranial hemorrhage in 1 case.ConclusionITP and GT are the primary causes of pregnancy with moderate-to-severe thrombocytopenia.Dexamethasone, immunoglobulin and platelet transfusion are effective methods for treatment.Platelet after treatment is lower than 50×109 L-1 as well as obstetrical indications cesarean delivery, should have good contractions to prevent postpartum hemorrhage, treatments have certain prevention of hemorrhage in cesarean section.Newborn babies should be monitoring platelet of ITP pregnant childbirth, for pregnant women with a history of splenectomy should be fully informed of severe neonatal thrombocytopenia and the possibility of neonatal intracranial hemorrhage.