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目的探讨妊娠合并血小板减少的病因,寻找其最佳的处理方法以促成良好妊娠结局。方法收集北京市垂杨柳医院2000-2008年收治的妊娠合并血小板减少的病例49例,对其发生的病因、处理方法及妊娠结局进行回顾性分析。结果妊娠合并血小板减少的主要原因包括:妊娠期血小板减少症(PAT)21例(42.86%),特发性血小板减少性紫癜(ITP)13例(26.53%),妊娠期高血压疾病7例(14.29%),系统性红斑狼疮2例(4.08%),妊娠期肝内胆汁淤积症(ICP)2例(4.08%),病因不明4例(8.16%)。有剖宫产指征的27例行剖宫产术结束妊娠,其余22例阴道分娩。产后出血1例,产后出血率2.04%。胎死宫内2例。新生儿血小板计数低于正常者4例。结论多种原因可引起妊娠期孕妇血小板减少,PAT是最常见类型。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严重妊娠合并血小板减少的有效手段。在术前和分娩前若能及时补充新鲜血及血小板,使血小板计数≥50×109/L以上者,无产科手术指征可阴道分娩。
Objective To investigate the etiopathogenisis of thrombocytopenia in pregnancy and to find out the best treatment method to promote good pregnancy outcome. Methods 49 cases of pregnancy-induced thrombocytopenia in Weeping Willow Hospital collected from 2000 to 2008 in Beijing were collected. The etiology, treatment and pregnancy outcome were retrospectively analyzed. Results The main causes of thrombocytopenia in pregnancy included gestational thrombocytopenia (PAT) in 21 cases (42.86%), idiopathic thrombocytopenic purpura (ITP) in 13 cases (26.53%), gestational hypertension in 7 cases 14.29%), 2 cases of systemic lupus erythematosus (4.08%), 2 cases of intrahepatic cholestasis of pregnancy (ICP) in 2 cases (4.08%) and 4 cases (8.16%) of unknown etiology. Cesarean indications of 27 cases of cesarean section to end the pregnancy, and the remaining 22 cases of vaginal delivery. Postpartum hemorrhage in 1 case, postpartum hemorrhage rate of 2.04%. 2 cases of fetal death. Neonatal platelet count was lower than normal in 4 cases. Conclusion A variety of reasons can cause thrombocytopenia in pregnant women, PAT is the most common type. On the basis of the treatment of etiology, glucocorticoids and platelet preparations are effective treatments for severe pregnancy with thrombocytopenia. Preoperative and preoperative delivery of fresh blood and platelets in time if the platelet count ≥ 50 × 109 / L or more, obstetric indications can be vaginal delivery.