晚期妊娠合并血小板减少50例临床分析

Clinical Analysis of 50 Cases of Late Pregnancy with Thrombocytopenia

目的 探讨晚期妊娠合并血小板减少的原因及围生期处理。方法 对潍坊市妇幼保健院在2001年6月至2008年8月收治的50例晚期妊娠合并血小板减少患者的临床资料进行回顾性分析。结果 晚期妊娠合并血小板减少的主要原因包括妊娠相关性血小板减少，特发性血小板减少性紫癜和妊娠期高血压疾病。在治疗原发病的基础上，血小板计数〈50×10^9／L的患者分娩前应用糖皮质激素，术前或分娩期输新鲜血小板和新鲜冰冻血浆。50例中31例经阴分娩，19例剖宫产；产后出血15例，新生儿颅内出血3例。结论 晚期妊娠合并血小板减少病因主要为妊娠合并血小板减少和特发性血小板减少性紫癜。在针对病因治疗的基础上，糖皮质激素及血小板制剂是治疗晚期妊娠合并血小板减少的有效手段。

Objective To study the etiology of thrombocytopenia with late pregnancy and management during various labor states in the course of delivery. Methods Clinical data of 50 hospitalized pregnant women with decreased blood platelets count （ 〈 100 × 10^9/L） during June 2001to August 2008 in Weifang hospital of maternal and child health were retrospectively reviewed. Results The etiology of gestational thrombocytopenia included pregnancy-associated thrombocytopenia , idiopathic thrombocytopenie purpura and hypertensive disorder complicating pregnancy, aplastie anemia,leukemia, and so on. Treatment was depended on the primary disease,glueoeortieoid was given to those with platelet count less than 50 × 10^9/L for a short time and fresh platelets and fresh frozen plasma were performed during or after delivery. Among the 50 cases, vaginal delivery and cesarean section were performed in 31 and 19 cases, respectively. Postpartum hemorrhage occurred in 15 cases and neonate intracranial hemorrhage in 3 cases. Conclusion The management during various labor states in the course of delivery is important. Glucocorticoid and platelet transfusion are effective methods for thrombocytopenia in late pregnancy in addition to the treatment for the primary disease.