Clinical Analysis of 216 Cases of Thrombocytopenia in Pregnancy
|Course||Obstetrics and Gynaecology|
|Keywords||Gestation Thrombocytopenia Pregnancy outcomes Postpartum hemorrhage|
Objective: To investigate the cause of pregnancy with thrombocytopenia, clinical treatment countermeasures, and the outcome of the mother and child. Methods: Qilu Hospital of Shandong University from 2000 to 2007 a total of 216 cases of pregnant women with platelet reducing cases (study group), diagnostic criteria for pregnancy twice a platelet count <100 × 10 ~ 9 / L, recorded maternal age, maternal time etiology, clinical manifestations, thrombocytopenia, complications of the situation, laboratory tests (blood count, coagulation, liver and kidney function, bone marrow, immune indicators), treatment, delivery and anesthesia, postpartum hemorrhage and newborn 216 cases of child outcome indicators; randomly selected the same period of platelet normal pregnant women as a control group, comparing the rate of cesarean section, postpartum hemorrhage rate. Results: During the study period pregnancy with platelets reduced in patients with 216 cases, the total number of deliveries over the same period to 16,556 cases, pregnant women with thrombocytopenia occurred was 1.30%, including pregnancy-related thrombocytopenia, accounting for 62.96% (136/216), followed by idiopathic thrombocytopenic purpura (12.96%), and hypertensive disorders in pregnancy (11.11%) reduction, and other rare causes aplastic anemia, systemic lupus erythematosus, megaloblastic anemia, acute fatty liver of pregnancy, anti- phospholipid syndrome, thrombotic thrombocytopenic purpura, postpartum hemolytic uremic syndrome, disseminated intravascular coagulation, drug-induced thrombocytopenia, viral infection. Treatment on the basis of the treatment of the primary disease, platelet count <20 × 10 9 / L or the third trimester platelet count <50 × 10 9 / L, bleeding tendency, especially in the termination of pregnancy before glucocorticoids, gamma globulin, platelet preparations. 216 cases of patients with thrombocytopenia, vaginal delivery in 86 cases (39.81%), 130 cases (60.19%) of cesarean section, when compared to the mode of delivery admission platelet count, the difference was statistically significant (P <0.05). The control group cesarean section rate was 52.31%, compared with the cesarean section rate of the study group, the difference was not significant (P> 0.05). The research group, the postpartum hemorrhage in 8 cases, postpartum hemorrhage rate was 3.70%, the control group, postpartum hemorrhage, postpartum hemorrhage rate was 2.31%, the two groups of postpartum hemorrhage rate difference was not statistically significant (P> 0.05). Cesarean study group of 130 cases, 103 cases using local anesthesia and intravenous anesthesia, two cases of anesthesia, 25 cases were treated with continuous epidural anesthesia and postoperative epidural hematoma and other complications does not appear. 216 patients with a total of childbirth neonatal 220, neonatal death cases, thrombocytopenia four cases of intracranial hemorrhage in 2 cases. Conclusions: The leading the pregnant women thrombocytopenia reasons a lot of pregnancy correlation thrombocytopenia, pregnancy with idiopathic thrombocytopenic purpura, hypertensive disorders in pregnancy is the main reason for pregnant women with thrombocytopenia. Glucocorticoid treatment for the cause on the basis of gamma globulin, platelet agents is an effective means of treating severe pregnancy with thrombocytopenia. The pregnancy with thrombocytopenia in patients with the mode of delivery depends on platelet levels and obstetric relevant. Pregnant women with thrombocytopenia do not increase the incidence of postpartum hemorrhage. Preoperative platelet count <100 × 10 9 / L, anesthesia, local anesthesia plus intravenous anesthesia is appropriate. Severe neonatal thrombocytopenia rare.