中重度血小板减少对孕妇围生期结局的影响

目的 探讨妊娠合并中度至重度血小板减少的病因、并发症及其妊娠结局.方法 回顾性分析169例妊娠合并中度至重度血小板减少患者(血小板减少组)的临床资料,并以同期171例无血小板减少孕妇为对照组,比较两组间并发症及妊娠结局的差异.结果 血小板减少的病因主要包括妊娠相关性血小板减少(63.3％),特发性血小板减少性紫癜(7.1％),先兆子痛(13.0％)及溶血、肝酶升高及血小板减少综合征(8.3％)等.与对照组比较,血小板减少组年龄明显大于对照组(31.6±4.8)岁vs.( 29.7±3.7)岁](P＜0.05),引产率(31.3％vs.9.9％)、早产率(27.5％vs.9.7％)及胎盘早剥发生率(9.5％vs.2.6％)均高于对照组(P＜0.05).血小板减少组新生儿出生5 min低Apgar评分(＜7)的发生率(10.1％vs.1.7％)、胎儿宫内发育迟缓发生率(9.5％vs.2.1％)及死产率(7.7％vs.0.0％)均较对照组高(P＜0..05),分层分析显示这些不良围生期结局在妊娠合并重度血小板减少患者发生率更高(P＜0.05).结论 妊娠合并中度至重度血小板减少显著增加围生期并发症及不良结局发生率.这些不良结局与血小板较少程度呈相关性,对妊娠合并重度血小板较少患者需格外关注.

Influence of moderate to severe thrombocytopenia during pregnancy on peripartum outcomes

Objective To investigate the etiological factors,complications and perinatal outcomes of pregnant women complicated by moderate to severe thrombocytopenia.Methods 169 pregnant women with moderate to severe thrombocytopenia were retrospectively evaluated and the perinatal outcomes were compared with 171 normal pregnant women as the control group.Results The main causes of thrombocytopenia were gestational thrombocytopenia(GT)(63.3%),idiopathic thrombocytopenic purpura(ITP)(7.1%),preeclampsia(13.0%) and hemolysis,elevated liver enzymes and low platelet count(HELLP) syndrome(8.3%).Compared with the control group,the age in the thrombocytopenia group were significantly older(31.6±4.8 vs.29.7±3.7),the rate of labor induction(31.3% vs.9.9%),the rate of preterm delivery(27.5% vs.9.7%) and the rate of placental abruption(9.5% vs.2.6%) were all higher(P<0.05).In a comparison of perinatal outcomes,the rates of Apgar scores <7 at 5min(10.1% vs.1.7%,P<0.05),intrauterine growth retardation(IUGR,9.5% vs.2.1%,P<0.05) and the stillbirth rate(7.7% vs.0.0%,P<0.05) were all higher than those in the control group.The stratified analysis showed that the incidence of these adverse perinatal outcomes in the pregnant women with severe thrombocytopenia were higher than that without moderate to severe thrombocytopenia(P<0.05).Conclusion Moderate to severe maternal thrombocytopenia significantly increases the incidence of perinatal complications and adverse outcomes.These adverse outcomes are associated with degrees of thrombocytopenia,which suggests that we should pay special attention to the patients with severe thrombocytopenia during pregnancy.