妊娠期血小板减少93例临床探讨

Clinical analysis of 93 patients with gestational thrombocytopenia.

目的：探讨妊娠期血小板减少（gestational thrombocytopenia，GT）对母儿的影响、处理以及分娩方式的选择。方法：回顾分析2005年1月至2006年6月93例GT患者的临床资料。结果：GT占妊娠合并血小板减少症的86．9％。血小板计数（3l-50）×10^9／L8例，占8．6％；（5l-99）×10^9／L85例，占91．4％。经糖皮质激素治疗3例，均在分娩前施行冲击治疗；4例在剖宫产时输注血小板。阴道分娩2l例，剖宫产72例（产科因素剖宫产42例）。产后出血6例。新生儿血小板计数均正常。结论：妊娠期血小板减少母儿预后好，GT在妊娠期不需要治疗，血小板计数〈50×10^9／L者在临近分娩前最好进行激素冲击治疗；GT患者不一定输注血小板。除非伴有临床出血症状，GT孕妇应以产科指征决定分娩方式。

Objective：To observe the effect of gestational thrombocytopenia （GT） on mother and fetal and determine the optimal management and how to choose the way of delivery. Methods：The clinical data of 93 patients with GT from Jan. 2005 to Jun. 2006 in our hospital was analysed restrospectively. Results： The incidence of GT in thrombocytopenia in pregnancy was 86.9%. The platelet count in 8 cases with GT was between 31 × 10^9/L - 50 × 10^9/L （8.6%） ,85 cases was between 51 × 10^9/L - 99 × 10^9/L（91.4% ）. 3 cases treated with pulsed high dose dexamethasone before imminent delivery. 4 cases received platelet transfu- sions. 21 patients vaginal delivered,72 patients cesarean delivered （42 for obstetric factors）. There were no cases of coagulation disturbance at delivery or in the postpartum period. Throm- bocytopenia was not observed in any neonate born to mothers with GT. Conclusion： Pregnant women and neonate with GT have well prognosis. No intervention is necessary during pregnan- cy. Treatment with pulsed high dose dexamethasone should be applied as labour and delivery approach if platelet count is less than 50 x 109/L. Platelet transfusions are unnecessary in women with GT. The mode of delivery should be determined by purely obstetric indications un- less there is clinical bleeding symptoms.