| Objective: Pregnancy thrombocytopenia is the generic name of a series of diseases. It is a common complication with pregnancy. The incidence rate of pregnancy thrombocytopenia was 5-8%.This disease can result in abortion,immature labor,fetus embarrassment,fetus hypoevolutism,fetus death,neonatel death,pregnnacy bleeding,neonatel cerebral hemorrhage,postpartum hemorrhage and other much more seriously complication. And this induce burden to the families and the society. So at present, we have pay more atteation to the etiopathogenisis,diagnosis,treatment and prevention of pregnancy thrombocytopenia.We are a big country with millions of pregnancy, to understand the etiopathogenisis,diagnosis,treatment and prevention of pregnancy thrombocytopenia can degrade the mortality of the pregnancy and rise up the living quality of the neonate.The study is to discuss the etiopathogenisis,diagnosis,treatment and prevention of pregnancy thrombocytopenia to provid clinical rationale.Methods: We analyzed retrospectively the 79 medical records from January, 2001 to December, 2007 that have been diagnosised as pregnancy thrombocytopenia in Jilin university No. 1 hospital, and 50 medical records of full-term delivery that we drown random at the same time as control group. We analysis the etiopathogenisis,clinical manifestation and treatment and compared the neonatal outcome,fetus embarrassment,fetus hypoevolutism,fetus death,neonatel death, delivery style,anesthesia style,postpartum hemorrhage with platelet count during less than 20×109 /L, 20-50×109 /L, more than 50×109 /L and the normal control group.Results: Among the 1308 cases of pregnancy,79 cases were found as pregnancy thrombocytopeni, the iccidence rate was 6.04% in the past 8 years in our hospital. Thrombocytopenia in pregnancy was mainly caused by prenacy-associated thrombocytopenia(PAT) in 28(34.44%) cases, idiopathic thrombocytopenia(ITP) in 7 cases(8.86%), aplastic anemia (AA) in 15 cases(18.99%), megaloblastic anemia(MA) in 8 cases(10.18%), hepatic disease in pregnancy in 1 (1.27%) cases, pregnancy induced hypertension in 8 (10.13%) cases, other hematologic disease and immunologically mediated disease in 13(16.46%) cases. Thrombocytopenia was identified initially at 5+5weeks of gestation, 9(11.40%) cases were found before 12 weeks. 11(13.92%) cases were found between 12 and 28 weeks, 59(74.68%) cases were found after 28 weeks,in this 59 cases 23(38.98%) cases were preterm delivery, and 36(61.12%) cases were full-term delivery. We can find according to the progression of the gestation, the cases of pregnancy thrombocytopeni trend to increase. But the platelet count of this three different period do not have significant difference. The etiopathogenisis of thrombocytopeni has significant difference at different platelet count. AA is the main reason for platelet count less than 20×109 /L, and PAT is the main reason for platelet count during 20-50×109 /L and more than 50×109 /L .Compared the clinical manifestation, we get that the more seriously the platelet count decrease, the significanter the clinical manifestation is. Among the 59 case, vaginal delivery and cesarean section were done in 8and 51 cases respectively. It is found the delivery way was significantly different by the platelet count during less than 20×109 /L,20-50×109 /L, more than 50×109 /L and the normal control group. We do more cesarean section compared with the normal control group, and the lower the platelet count is, the more cesarean section we used. If we can get fresh whole blood, platelets, and fresh frozen plasma transfusion, we may try the vaginal delivery. We need to choose diffient anesthesia style at ditterent platelet count. We mostly use local anesthesia or general anaesthesia when the platelet count is less than 20×109 /L while we choose lumbar anesthesia or epidural anesthesia when the platelet count is more than 50×109 /L. When the platelet count is 20-50×109 /L, we may try lumbar anesthesia or epidural anesthesia if we can get fresh whole blood, platelets transfusion.5 cases occur postpartum hemorrhage,1was a vaginal delivery case. The incidence of postpartum hemorrhage was 8.47%. We found postpartum hemorrhage rate was more than nomal PLT group, at the same time, we find there is no significant different between vaginal delivery and cesarean section. Compared the neonatal outcome: birth weight(BW),biparietal diameter(BPD),apgar score for one minite of the preterm delivery team,full-term delivery team in the thrombocytopenia cases and the normal control group. We get this three indexes were different significantly. The normal control group is higher than the thrombocytopenia team. The normal control group is higher than the full-term delivery team, and full-term delivery team is higher than the preterm delivery team. Compared the neonatal outcome with the platelet count at less than 20×109 /L,20-50×109 /L and more than 50×109 /L. Found that the BPD and the apgar score for one minite had no significant different. The BW of the less than 20×109 /L team is lighter than the more than 50×109 /L team. Compared the normal control group with the platelet count less than 20×109 /L,20-50×109 /L and more than 50×109 /L ,the incidence of fetus embarrassment,fetus hypoevolutism have significant difference among the four teams while the fetus death and the neonatel death have no difference. Treatment method: treatment was depended on the primary disease, and fresh whole blood, platelets, and fresh frozen plasma transfusion were performed during or after delivery. Natural vaginal delivery is permitted if no indication of cesarean section presented. The transfusion of platelet was necessary for patients with platelet less than 50×109/L Prednisone was considered if the platelet count was less than 50×109/L. If the platelet count was less than 50×109/L esarean delivery might be performed. Mother with ITP may affect infant.Conclusion: The iccidence rate was 6.04% in the past 8 years in our hospital. Thrombocytopenia in pregnancy was mainly caused by prenacy-associated thrombocytopenia(PAT). The other etiological factors including diopathic thrombocytopenia(ITP),aplastic anemia (AA),megaloblastic anemia(MA),hepatic disease in pregnancy,pregnancy induced hypertension,hematologic disease and immunologically mediated disease .We find according to the progression of the gestation, the cases of pregnancy thrombocytopeni trend to increase. But the platelet count of this three different period do not have significant difference. The etiopathogenisis of thrombocytopeni has significant difference at different platelet count. AA is the main reason for platelet count less than 20×109 /L, and PAT is the main reason for platelet count during 20-50×109 /L and more than 50×109 /L. The clinical manifestation exist with the low platelet count. The delivery way was significantly different by the platelet count during less than 20×109 /L, 20-50×109 /L, more than 50×109 /L and the normal control group. We do more cesarean section compared with the normal control group, and the lower the platelet count is the more cesarean section we used. Delivery way should be chosen according to fetal body weight, mothers' cervical indication and so on. If we can get fresh whole blood, platelets, and fresh frozen plasma transfusion, we may try the vaginal delivery. We need to choose different anesthesia style at different platelet count. We mostly use local anesthesia or general anaesthesia when the platelet count is less than 20×109 /L while we choose lumbar anesthesia or epidural anesthesia when the platelet count is more than 50×109 /L. When the platelet count is 20-50×109 /L, we may try lumbar anesthesia or epidural anesthesia if we can get fresh whole blood, platelets transfusion. The incidence of postpartum hemorrhage was more than nomal PLT group, and there is no significant different between vaginal delivery and cesarean section. Compared the neonatal outcome: birth weight(BW),biparietal diameter(BPD),apgar score for one minite of the preterm delivery team,full-term delivery team. The normal control group is higher than the thrombocytopenia team. The normal control group is higher than the full-term delivery team, and full-term delivery team is higher than the preterm delivery team. Compared the neonatal outcome with the platelet count at less than 20×109 /L,20-50×109 /L and more than 50×109 /L. Found that the BPD and the apgar score for one minite had no significant different. The BW of the less than 20×109 /L team is lighter than the more than 50×109 /L team. The incidence of fetus embarrassment,fetus hypoevolutism have significant difference among the four teams while the fetus death and the neonatel death have no difference. Treatment was depended on the primary disease and fresh whole blood, platelets, and fresh frozen plasma transfusion were performed during or after delivery. Natural vaginal delivery is permitted if no indication of cesarean section presented. The transfusion of platelet was necessary for patients with platelet less than 50×109/L. Mother with ITP may affect infant. |
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