妊娠合并血小板减少79例临床分析

目的:探讨妊娠合并血小板减少症的病因及分娩方式的选择。方法:回顾性分析79例妊娠合并血小板减少患者的病因及分娩方式。结果:79例病例中因妊娠相关性血小板减少症(PAT)28例,妊娠期高血压疾病8例,再生障碍性贫血15例,巨幼细胞性贫血8例,血小板减少性紫癜7例,其他血液或免疫性疾病13例。血小板水平减少至20×109/L以下者26例(32.91%),主要以再生障碍性贫血为主,血小板水平减少在(20～50)×109/L之间33例,以特发性血小板减少为主。血小板水平在(50～100)×109/L之间20例,仍以特发性血小板减少为主。79例病例中,妊娠晚期终止59例,剖宫产51例,自然分娩8例;其中血小板水平减少至20×109/L以下者19例,剖宫产分娩者18例,血小板水平减少在(20～50)×109/L之间者23例,剖宫产分娩者22例(95.65%),血小板水平在(50～100)×109/L之间17例,剖宫产11例。结论:妊娠合并血小板减少发病率为6.04%,其中以妊娠相关性血小板减少症(PAT)为主要病因,其他病因还有妊娠高血压综合征、再生障碍性贫血、巨幼细胞性贫血、ITP引起、其他血液或免疫性疾病、肝硬化、脾功能亢进等。血小板降低水平不同,其病因构成不同,重度血小板减少以再生障碍性贫血为主,轻、中度血小板减少以PAT为主,剖宫产为主要分娩方式。随着血小板的增加,自然产的比例逐渐增加。

Clinical analysis of 79 patients with pregnancy complicated with thrombocytopenia

Objective:To discuss the etiopathogenisis and the delivery modality of the pregnancy complicated with thrombocytopeniaMethods:Retrospective analyze the etiopathogenisis,choice of delivery modality of the 79 cases with pregnancy complicated with thrombocytopenia from January,2001 to December,2007.Results:Among the 1 308 cases of pregnancy,79 cases were found as pregnancy complicated with thrombocytopenia,the incidence rate was 6.04% in the past 8 years. Thrombocytopenia in pregnancy was mainly caused by prenacy-associated thrombocytopenia(PAT) in 28(34.44%) cases,idiopathic thrombocytopenia(ITP) in 7 cases(8.86%),aplastic anemia (AA) in 15 cases(18.99%),megaloblastic anemia(MA) in 8 cases(10.18%),hepatic disease in pregnancy in 1 (1.27%) cases,pregnancy induced hypertension in 8 (10.13%) cases,other hematologic disease and immunologically mediated disease in 13(16.46%) cases. 59(74.68%)cases were found after 28 weeks,in this 59 cases 23(38.98%) cases were preterm delivery,and 36(61.12%) cases were full-term delivery. Among the 59 case,vaginal delivery and cesarean section were done in 8 and 51 cases respectively.During the 51 cases ,at less than 20×109/L,20~50×109/L and more than 50×109/L.It was found the delivery way was significantly different by the platelet count during less than 20×109/L,20~50×109/L,more than 50×109/L and the normal control group.Conclusion:The incidence rate was 6.04% in the past 8 years in our hospital. Thrombocytopenia in pregnancy is mainly caused by prenacy-associated thrombocytopenia(PAT).The other etiological factors including diopathic thrombocytopenia(ITP),aplastic anemia(AA),megaloblastic anemia(MA),hepatic disease in pregnancy,pregnancy induced hypertension,hematologic disease and immunologically mediated disease The etiopathogenisis of thrombocytopeni has significant difference at different platelet count AA is the main reason for platelet count less than 20×109/L,and PAT is the main reason for platelet count during 20~50×109/L and more than 50×109/L. Abdominal delivery is the main delivery way.