妊娠合并特发性血小板减少性紫癜18例临床分析

Idiopathic thrombocytopenic purpura in pregnancy:Report of 18 cases

目的:探讨妊娠合并特发性血小板减少性紫癜(ITP)的围生期处理方法。方法:回顾性分析18例妊娠合并ITP的临床资料。治疗以皮质激素及免疫球蛋白为主,对血小板计数<50×109/L者于分娩前后短期使用血小板制剂。结果:18例中阴道分娩6例,剖宫产12例。发生产后出血2例,晚期产后出血1例,产后出血发生率为11.1%。全部病例无孕产妇死亡及新生儿血小板减少。结论:对于妊娠合并ITP的孕妇应加强孕期监护及治疗。如无产科指征时以阴道分娩为宜。对血小板<50×109/L或有其他产科并发症者可在输血小板且血源充足的情况下剖宫产。

Objective ：To explore the optimal management of idiopathic thrombocytopenic pmpura（ITP） in pregnancy. Methods：The data of 18 cases of ITP in pregnancy were studied retrospectively. For the patients with ITP, prednisone or intravenous immunoglobulin （IVIG） was the first choice. Short-term platelet transfusion was given to those with platelet count less than 50×10^9/L. Results： Among the 18 cases, vaginal delivery and cesarean section were performed in 6 and 12 cases, respectively; the occurrence of postpartum hemorrhage was 11.1%. No maternal death occurred, and no neonatal thrombocytopenic was observed. Conclusions：We must reinforce obstetrical surveillance and management of ITP in pregnancy. We suggest that ITP mothers without obstetrical complications adopt vaginal delivery. Cesarean delivery should be performed to those whose platelet count is less than 50×10^9/L or with other obstetrical complications when there is sufficient fresh blood and platelet.