妊娠合并重度血小板减少96例临床分析

Clinical Analysis of 96 Cases of Pregnancy Complicated with Severe Thrombocytopenia

目的探讨妊娠合并重度血小板减少的病因、治疗方案、分娩方式及母儿结局。方法回顾性分析2016年1月至2019年1月在同济医院妇产科分娩的96例妊娠合并重度血小板减少患者的临床资料。结果该组病例中妊娠合并重度血小板减少的主要原因是特发性血小板减少症(ITP)(47例,49.0%);糖皮质激素治疗有效率71.4%,地塞米松+丙种球蛋白治疗有效率100.0%,血小板输注治疗有效率84.3%,采用3种方案在治疗前后血小板计数的差异均有统计学意义(均P<0.01)。Pearson相关分析结果显示剖宫产/阴道分娩孕妇产前PLT水平与产后出血量均呈负相关(r=-0.345,P=0.002;r=-0.491,P=0.039);两种分娩方式产后出血量比较,差异有统计学意义(P<0.01)。6例新生儿血小板减少(NITP)的母亲均为ITP患者,其中2例产妇有脾切除史。结论妊娠合并重度血小板减少的原因以ITP为主。糖皮质激素、丙种球蛋白和血小板制剂是治疗的有效手段。分娩方式应以产科指征为主要依据,加强子宫收缩可预防产后出血。新生儿需监测血小板计数,对于ITP或有脾切除史的孕妇应充分告知发生严重新生儿血小板减少的风险。

Objective To investigate the etiology,optimal treatment plan,delivery mode and maternal and fetal outcomes of pregnancy with severe thrombocytopenia.Methods The clinical data of 96 pregnant patients with severe thrombocytopenia who delivered in our hospital from January 2016 to January 2019 were retrospectively analyzed.Results The main cause of severe thrombocytopenia in pregnancy was idiopathic thrombocytopenia(ITP)(47 cases,49.0%). Treatment with glucocorticoid was effective in 71.4% patients with severe thrombocytopenia,and dexamethasone + gamma globulin therapy was effective in 100% patients,and platelet transfusion was effective in 84.3% patients. The difference of platelet counts before and after treatment was statistically significant(P<0.01). Pearson correlation analysis showed that prenatal PLT level was negatively correlated with amount of postpartum bleeding(P =0.002,r=-0.345;P =0.039,r=-0.491). There was significant difference in the amount of postpartum bleeding between vaginal delivery and caesarean section(P<0.01). Six mothers with neonatal thrombocytopenia(NITP) babies were ITP patients,and 2 of them had a history of splenectomy. Conclusion Most severe thrombocytopenia in pregnancy is ITP. Glucocorticoids,gamma globulins,and platelet preparations are effective treatments. The mode of delivery should be based on obstetric indications,and strengthening uterine contractions can prevent postpartum hemorrhage. Platelet counts in neonates should be monitored. For pregnant women with ITP or a history of splenectomy,the risk of severe neonatal thrombocytopenia should be adequately informed.