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目的探讨妊娠合并血小板减少患者的围生期处理及母婴结局。方法选择我院2006年1月~2008年8月间106例妊娠合并血小板减少患者,按血小板水平分为A组26例(PLT≤50×109/L);B组80例(PLT>50×109/L)。回顾分析各组患者的围生期处理方法及母婴结局。结果A组患者分娩前采用糖皮质激素和或丙种球蛋白治疗,分娩前后输注血小板悬液。B组患者分娩前采用氨肽素、益血生及维生素C等一般支持治疗。A组中显效3例(占11.54%),良效12例(占46.15%),进步7例(占26.92%),无效4例(占15.38%)。A组中剖宫产22例,占84.62%,B组中剖宫产51例,占63.75%,两组比较A组剖宫产率明显高于B组,差异具有统计学意义(P<0.05)。A组产后出血发生率15.38%,B组产后出血发生率11.25%,两组比较无明显差异(P>0.05)。2组中新生儿出生后无1例新生儿死亡、颅内出血及其他血小板减少相关疾病发生。结论糖皮质激素、丙种球蛋白及输注血小板均为治疗妊娠期严重血小板减少的有效手段。对分娩前血小板>50×109/L的患者无须特殊处理,对分娩前血小板≤50×109/L的患者应做重点监护,可适当放宽剖宫产手术指征,确保母婴安全。
Objective To investigate perinatal treatment and maternal-infant outcome in patients with pregnancy complicated with thrombocytopenia. Methods 106 cases of pregnancy with thrombocytopenia in our hospital from January 2006 to August 2008 were divided into two groups according to the level of platelet: PLT≤50 × 109 / L; PLT≥50 × 109 / L). Retrospective analysis of each group of patients with perinatal treatment and maternal and child outcomes. Results Patients in group A were treated with glucocorticoid or gamma globulin before delivery and platelet suspension before and after delivery. B group of patients before delivery with aminopeptidase, beneficial blood and vitamin C and other general supportive treatment. In group A, 3 cases were significant (11.54%), 12 cases were good (46.15%), 7 cases were advanced (26.92%) and 4 cases was ineffective (15.38%). A group of 22 cases of cesarean section, accounting for 84.62%, 51 cases of cesarean section in group B, accounting for 63.75%, the two groups compared cesarean section rate was significantly higher than group B, the difference was statistically significant (P <0.05 ). The incidence of postpartum hemorrhage in group A was 15.38%, and that in group B was 11.25%. There was no significant difference between the two groups (P> 0.05). Neonatal death, intracranial hemorrhage and other thrombocytopenia-related diseases occurred in none of the 2 newborn infants after birth. Conclusion Glucocorticoid, gamma globulin and platelet transfusion are both effective methods for the treatment of severe thrombocytopenia during pregnancy. Pre-delivery of platelets> 50 × 109 / L of patients without special treatment, before delivery of platelets ≤ 50 × 109 / L patients should do intensive care, may be appropriate to relax cesarean section indications to ensure the safety of mother and child.