Clinical Analysis Of Pregnancy With Thrombocytopenia

Objective:This thesis is for investigating the changes of etiology,diagnosis,treatment and maternal,infant outcomes of pregnancy with thrombocytopenia after the second-child policy,and for studying the corresponding perinatal management of these pregnant women,which can improve the outcome of maternal and infant.Methods:1.The subjects of the study were composed of 310 pregnant women who got the prenatal examination in Department of Obstetrics and Gynecology,Affiliated Hospital,Yangzhou University and met the criteria for diagnosis of pregnancy with thrombocytopenia during January 2015 and December 2019.These women were made groups according to the degree of thrombocytopenia.Respectively:there were 195 cases in Group I with mild thrombocytopenia(50×10~9/l<PLT<100×10~9/l),and 74 cases in Group II with moderate thrombocytopenia(30×10~9/l<PLT≤50×10~9/l),but only 41cases in Group III with severe thrombocytopenia group(PLT≤30×10~9/l).In addition,the Control Group IV contained 100 normal pregnant women with normal platelets from the same period.Relevant data were collected separately.For mummy these data included the age,number of pregnancies,number of births,single or twin births,lowest prenatal PLT,prenatal PLT,coagulation function four items,D-dimer,hemoglobin(Hb),etiology,bleeding symptoms,related treatment,expected date of delivery,indications of delivery,postpartum hemorrhage,the platelet recovery rate at 42 days postpartum,lochia and the incidence of puerperal infection.For baby these data contained premature delivery,birth weight,Apgar scores,neonatal thrombocytopenia,Hb,treatment and the cases of transfer to pediatrics.2.SPSS23.0 software was used to analyze the various factors between groups statistically.The measurement data are expressed as mean±standard deviation(x±s)and the multiple sample mean is compared by non-parametric test.The counting data is shown by composition ratio,and is measured by χ~2 test or Fisher exact probability test.If p<0.05 the statistical significance is indicated for the difference.Results:1.In the general data of pregnant women,there were no significant difference in age,number of pregnancies,number of births,single or twin births among the four groups.For comparison of the incidence of bleeding symptoms:Group III>Group II>Group I,the statistical significance was found in the difference between groups.2.In the etiological analysis,gestational thrombocytopenia(GT)、idiopathic thrombocytopenic purpura(ITP)、hypertensive disorders of pregnancy(HDP)、other etiologies and unknown etiology was 68.39%、8.39%、5.81%、6.45%and 10.96%,respectively,for the all cases.For other etiologies,anti-phospholipid syndrome(APS)was a majority of 35%and systemic lupus erythematosus(SLE)for 25%.The remaining rare ones were hypersplenism,aplastic anemia(AA),myelodysplastic syndrome(MDS)and undifferentiated connective tissue disease(UCTD).3.The statistical significance was shown in the difference of etiology composition among groups.Comparison results of the distribution of different etiologies in three groups are as follows:GT:Group I>Group II>Group III,and the difference was statistically significant;ITP:Group III>Group II>Group I,and the difference was statistically significant;HDP:Group III>Group II>Group I,and the difference was not statistically significant;other etiologies:Group III>Group II>Group I,only the difference of Group I and the other two groups were statistically significant;the unknown etiology:Group III>Group II>Group I,the difference between Group I and Group III was statistically significant.4.There were no significant differences in the four coagulation functions(PT,TT,APTT,and FIB)、D-dimer and Hb among the four groups.By comparison of the mean value of lowest platelet during pregnancy:Group I>Group II>Group III,the difference between groups was statistically significant.5.By retrospective analysis of patients with thrombocytopenia during pregnancy treatment,and comparison of the rate of treatment for three groups:Group III>Group II>Group I,the lower platelet value,the higher rate of treatment,and the difference was statistically significant.Women(89.03%)were diagnosed clearly,and the treatment was mainly aimed at the primary disease.In 212 GT patients,94.81%were pregnant to full term.Sixteen women were treated with platelet transfusions under 50×10~9/L before delivery and 26 ITP patients received therapy with glucocorticoid(prednisone etc.)and immunoglobulin.Part of them received platelet transfusion therapy due to the extremely reduced platelets value,and 88.46%of the patients had full term of pregnancy;Eighteen HDP patients were treated for hypotension(labetalol,nifedipine,etc.),spasmolysis(magnesium sulfate),albumin supplementation,etc.Pregnant women(22.22%)terminated their pregnancies early because of poor therapeutic effects;Pregnant women(16)with rheumatic immune diseases received anti-rheumatic immunotherapy(fenlol,prednisone,cyclosporine,aspirin,heparin,etc.);and 13 pregnant women with low pre-delivery platelets received platelet transfusions.6.In maternal outcomes,there were no statistically significant differences in postpartum hemorrhage rates,lochia cleanness at 42 days postpartum and the incidence of puerperal infection among the groups.By comparison of the platelet recovery rate at 42 days postpartum:Group I>Group II>Group III,the difference between groups was statistically significant.By Comparison of the average gestational weeks:group IV>Group II>Group I>Group III,the difference between|Group III and the other three groups was statistically significant,and the difference between the remaining groups was not statistically significant.The total rate of cesarean section in Groups I,II,III and IV was 49.74%,67.57%,90.24%and 40%,respectively,and the cesarean section rate using platelet as the cesarean section was 1.54%,37.84%,and 78.05%,respectively,in the Groups I,II,III and IV.The rate of cesarean section in group III was significantly higher than that in other groups,and thrombocytopenia was used as the indication for most of cesarean sections.The differences between Group III and Groups I,II and IV,and between Group II and Group IV,were statistically significant.7.In neonatal outcomes,the difference of neonatal anemia between the four groups was not statistically significant.By comparison of the premature birth rate of newborns:Group III>Group II>Group I>Group IV,and by comparison of the mean birth weight of newborns:Group I>Group IV>Group II>Group III.Only the difference between Group III and the other three groups was statistically significant for these two indicators.By comparison of the 1’Apgar score and 5’Apgar score:Groups I,IV>Groups II,III,and the differences between Group III and Groups I,IV and Groups II,I and Group IV were statistically significant in 1’Apgar score,while the difference between Group III and the other three groups was statistically significant in 5’Apgar score.By comparison of the incidence of neonatal thrombocytopenia:Group III(23.81%)>Group II(6.67%)>Group I(0.0%),the difference between groups was statistically significant.Among the 15 cases of neonatal thrombocytopenia,14 cases were relative with maternal ITP,and 9 cases were newly diagnosed during pregnancy.The incidence of neonatal thrombocytopenia in ITP pregnant women was 53.85%.Except for the transfer to pediatrics due to preterm delivery,and by comparison of the neonatal transfer rate due to thrombocytopenia:Group III>Group II>Group I,the difference between groups was statistically significant.Conclusion:1.GT,ITP and HDP are the most common causes of thrombocytopenia in pregnancy,and the highest probability of severe thrombocytopenia is caused by ITP.2.When dynamic monitoring of blood routine and coagulation function during pregnancy,and strengthening monitoring of primary disease are processed,thrombocytopkonenia is not an absolute indication of termination of pregnancy.Strict perinatal management and delivery monitoring to such patients can reduce the rate of cesarean section.3.Special attention should be paid to the monitoring of newborns’platelets for ITP pregnant woman,especially for diagnosing ITP during pregnancy,so that unnecessary mother-infant separation and intervention can be reduced in newborns of pregnant women under the remaining causes.