妊娠合并血小板减少症130例临床分析

目的探讨妊娠合并血小板减少症的临床特点及妊娠期的监护和处理.方法对130例妊娠合并血小板减少患者的临床资料作回顾性研究.结果发现单纯由妊娠引起血小板减少94例(72.3%),特发性血小板减少性紫癜(ITP)引起12例(9.2%),合并肝脏疾病11例(8.5%),重度妊高征引起10例,先兆子痫4例,(共占10.8%), Rh血型不合及病毒感染各1例(各占0.8%).血小板减少出现最早孕周为17+4周,＜28周出现37例(28.5%),>28周出现93例(71.5%),3/4左右孕妇血小板减少出现在妊娠晚期.对血小板(5万u者用强的松治疗,分娩前后使用血小板制剂,同时考虑剖宫产.产后出血率为2.3%.新生儿血小板减少2例,头颅血肿1例.63例PT患者在产后1周血小板恢复正常.结论妊娠合并血小板减少一般发生在妊娠晚期,妊娠期血小板减少(PAT)是最常见的妊娠合并血小板减少症类型.有合并症的血小板减少程度严重,大多＜7万u,半数ITP有临床症状.糖皮质激素是治疗严重血小板减少的有效手段,术前血小板仍＜5万u可输注浓缩血小板.妊娠合并血小板减少症不增加产后出血的发生率.母亲合并ITP时,新生儿可能血小板减少.1/2患者血小板在产后1周左右恢复正常.

Clinical Analysis of 130 Thrombocytopenia in Pregnancy

Objective To explore the causes, management and outcome of pregnant women with thrombocytopenia. Methods Medical records from 1999 to 2003 were reviewed for diagnosis,treatment ,and neonatal outcome in 130 women with thrombocytopenia in Xinhua Hospital. Results Thrombocytopenia was mainly caused by prenancy-associated thrombocytopenia (PAT) in 94 (72 3%) cases,idiopathic thrombocytopenia(ITP) in 12 cases (9 2%),hepatic disease in pregnancy in 11 (8 5%)cases, pregnancy induced hypertension 10 cases and preeclampsia 4 (10 8%)cases, Rhesus isoimmunization and viral infection each 1(0 8%) case. Thrombocytopenia was identified initially at 17 +4 weeks of gestation,37 (28 5%) cases were found before 28 weeks,93 (71 5%) cases were found after 28 weeks. Prednisone was considered if the platelet count was less than 50,000/uL. Platelet transfusion was given to those with platelet count less than 50,000/uL before and after delivery. If the platelet count was less than 50,000/uL esarean delivery might be performed. The occurrence of postpartum hemorrhage was 2 3%. Bleeding occurred in two neonatals. One newborn suffered from cephalohematoma. Sixty-three cases PAT recovered spontaneousely within 1 week after delivery. Conclusion Pregnancy thrombocytopenia usually becomes evident in the third trimester. PAT is the most common type of thrombocytopenia during pregnancy. Pregnancy thrombocytopenia is not associated with bleeding diathesis in the mother. Degree of thrombocytopenia with complication was more severe(platelet count usually less than 70,000/uL). Half of ITP are symptomatic. Glucocorticoid is effective treatment for severe thrombocytopenia. Platelet transfusion may be considered when platelet count is still less than 50,000/uL before operation. Mother with ITP may affect infant.Besides therapy directing at the eiology, corticosteroids and platelet transfusion are effective treatment for severe thrombocytopenia during delivery. One half women return to a normal platelet count within one week after delivery.