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目的探讨妊娠期血小板减少的主要原因、孕期监护、分娩及产后的影响。方法回顾分析2003~2007年本院144例妊娠期血小板减少的临床资料,分析血小板减少的原因,分娩方式的选择,产后母婴并发症情况。结果144例中,妊娠相关性血小板减少症(pregnancy associated thrombocytopenia,PAT)是孕期血小板减少的主要原因,次之是妊娠合并特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)。当血小板小于或等于20×109/L时剖宫产采用全麻,产后出血、产后宫腔积血发生率高。8例给予糖皮质激素、免疫球蛋白治疗或输注血小板治疗,其中5例是妊娠合并ITP或再生障碍性贫血(再障),这5例中4例是血小板小于或等于20×109/L,在中孕期因患者担心药物引起胎儿畸形要求引产。结论妊娠期血小板减少以PAT多见,其次为ITP合并妊娠,当血小板小于或等于50×109/L以下有出血倾向,尤其是血小板降到20×109/L以下即使无出血倾向,应到血液科进行检查和治疗。分娩方式无剖宫产指征的可在严密监护下行阴道分娩,产时及产后给予缩宫素及止血治疗。不主张预防性治疗新生儿血小板减少。
Objective To investigate the main causes of thrombocytopenia in pregnancy, pregnancy monitoring, delivery and postpartum effects. Methods The clinical data of 144 cases of thrombocytopenia during pregnancy in our hospital from 2003 to 2007 were retrospectively analyzed. The causes of thrombocytopenia, the choice of mode of delivery and the complications of postpartum maternal and infant were analyzed. Results In 144 cases, pregnancy associated thrombocytopenia (PAT) was the main cause of thrombocytopenia during pregnancy, followed by pregnancy with idiopathic thrombocytopenic purpura (ITP). When the platelet is less than or equal to 20 × 109 / L, cesarean section with general anesthesia, postpartum hemorrhage, high incidence of postpartum uterine hemorrhage. 8 patients were given glucocorticoid, immunoglobulin therapy or infusion platelet therapy, of which 5 were pregnant with ITP or aplastic anemia (aplastic anemia), of which 4 were platelets less than or equal to 20 × 109 / L , In the second trimester due to patients worried about the drug caused fetal malformations require induction of labor. Conclusions Pregnancy thrombocytopenia is more common in PAT, followed by ITP with pregnancy, when the platelet less than or equal to 50 × 109 / L less bleeding tendency, especially platelets down to 20 × 109 / L or less even if there is no tendency to bleeding should be to the blood Section for examination and treatment. Mode of delivery without cesarean indications can be closely monitored down vaginal delivery, during delivery and postpartum oxytocin and hemostasis. Does not advocate prophylactic treatment of neonatal thrombocytopenia.