妊娠合并血小板减少112例临床分析

Clinical analysis of thrombocytopenia with pregnancy.

目的:探讨妊娠合并血小板减少的发病机制及围生期的处理方法。方法:回顾分析天津医科大学总医院1992年至2002年间112例妊娠合并血小板减少患者的病因及临床处理经验。结果:112例孕妇中特发性血小板减少性紫癜27例,占24.1%;子痫前期44例,占39.3%;妊娠期特发性血小板减少40例,占34.8%;血栓性血小板减少性紫癜1例,占0.89%。阴道分娩27例,剖宫产85例。产后出血13例,产褥感染1例。结论:多种原因可以导致妊娠妇女血小板减少。如无产科指征,以阴道分娩为宜;血小板<50×109/L时,在血源充足时行剖宫产。不主张采用侵入性检查方法确定胎儿血小板水平。

Objective：To study the pathogenesis and the optimal management of pregnant women with thrombocytopenia. Method：The outcomes of 112 pregnancies with thrombocytopenia about 10 years from 1992 to 2002 were analysed. Results：Among the 112 cases,the incidence of idiopathic thrombocytopenic purpura（ ITP）, preeclampsia, gestational thrombocytopenia（GT） and thrombotic thrombocytopenic purpura （TTP） were 24. 1%, 39.3%, 34.8%, 0. 89%, respectively. Vaginal delivery and cesarean section were done in 27 and 85 cases, respectively. The incidence of postpartum hemorrhage and infection were 11.6% and 0.89%, respectively. Conclusion：Thrombocytopenia in the pregnant patients may result trom a number ot causes,most of which involve either immune-mediated platelet destruction or platelet consumption. Pregnant women with thrombocytopenia can be delivered vaginaly if there is no obstetrical complications. Selected caesarean delivery should be performed in severely thrombocytopenic cases when there are sufficient fresh blood and platlet supply. The invasive interventions should not be recommended to detect the fetus platelet count.