Clinical Analysis Of 414 Cases Of Pregnancy Complicated With Thrombocytopenia

Objective:By retrospectively analyzing the relationship between the etiology and severity of pregnancy complicated with thrombocytopenia and pregnancy outcome and neonatal outcome,we can provide guidance for dealing with some common diagnosis and management decisions,so as to prevent the occurrence of hemorrhagic events,optimize delivery,and ensure the health of mother and fetus to the greatest extent.Methods:by reviewing the clinical data of 414 pregnant women with thrombocytopenia delivered in the first hospital of Jilin University from January 2011 to January 2021,the causes were analyzed and divided into five groups according to different causes:pregnancy idiopathic thrombocytopenia（PAT）group,idiopathic thrombocytopenic purpura（ITP）group,pregnancy induced hypertension（HDCP）group,other etiological groups（including AA,MA,SLE,APS,MDS,etc.）Unexplained group（with a history of thrombocytopenia before pregnancy but without definite diagnosis or systematic diagnosis and treatment）.The platelet values were counted and divided into mild group（50×10~9/L≤PLT<50×10~9/L）,moderate group（30×10~9/L≤PLT<50×10~9/L）,severe group（PLT<30×10~9/L）.The general clinical data（age,number of pregnancies,number of births,length of hospital stay）,time of onset,mode of delivery,postpartum hemorrhage rate,preterm birth rate,neonatal Apgar score,birth weight,asphyxia rate,incidence of low birth weight and transfer rate were analyzed and compared.Results:（1）etiological analysis of pregnancy complicated with thrombocytopenia:241 cases of pregnancy idiopathic thrombocytopenia,accounting for 58.2%;65 cases of idiopathic thrombocytopenic purpura,accounting for 15.7%;There were 40 cases of hypertensive diseases during pregnancy,accounting for 9.7%;There were 26 cases in other etiology group,accounting for 6.3%,including 8 cases of aplastic anemia,3 cases of megaloblastic anemia,4 cases of myelodysplastic syndrome,3 cases of systemic lupus erythematosus,5 cases of antiphospholipid antibody syndrome,1 case of intrahepatic cholestasis,1 case of iron deficiency anemia and 1 case of congenital thrombocytopenia;42 cases were unknown,accounting for10.1%.（2）Comparison of general clinical data:there was no significant difference in the number of pregnancies and births among the etiological groups（P>0.05）.The age of HDCP group was higher than that of other etiological groups,and the difference was statistically significant（P<0.05）.The hospitalization time of PAT group was shorter than that of other etiology groups,and the difference was statistically significant（P<0.05）.PAT and HDCP group mostly occurred in the middle and late pregnancy,while ITP group mostly occurred before and early pregnancy,the difference was statistically significant（P<0.05）.Most of the thrombocytopenia in ITP group were severe,and most of the thrombocytopenia in PAT group and HDCP group were mild,the difference was statistically significant（P<0.05）.There was no significant difference in the number of pregnancies and births among the groups（P>0.05）.The age of patients in severe group was higher than that in mild group,and the difference was statistically significant（P<0.05）.The length of hospital stay in the severe group was significantly longer than that in the mild and moderate groups（P<0.05）.（3）Comparison of pregnancy outcomes:there was no significant difference in cesarean section rate and postpartum hemorrhage rate among the etiological groups（P>0.05）.There were 11 cases of fetal death in utero,and426 newborns（including 23 twins）were delivered.There was no significant difference in neonatal Apgar score,neonatal asphyxia rate and transfer rate among the etiological groups（P>0.05）.The weight of newborns in pat group was significantly higher than that in ITP group and HDCP group（P<0.05）.The incidence of preterm birth and low birth weight in HDCP group were significantly higher than those in other etiological groups（P<0.05）.There was no significant difference in cesarean section rate and postpartum hemorrhage rate in different degrees of thrombocytopenia（P>0.05）.There was no significant difference in neonatal Apgar score,premature delivery rate,neonatal asphyxia rate,transfer rate and low weight incidence among all degree groups（P>0.05）.The weight of newborns in severe group was significantly lower than that in mild and moderate group（P<0.05）.There was no significant difference in the incidence of postpartum hemorrhage among different delivery methods（P>0.05）.（4）Treatment:there were 241 cases of pat in the etiology group,most of which had no special treatment,accounting for 60.2%.The degree of thrombocytopenia was divided into moderate and severe groups.There were 42cases,accounting for 58.3%.Conclusion:（1）the main causes of pregnancy complicated with thrombocytopenia are PAT,ITP and HDCP,and other causes are rare.PAT and HDCP were mostly mild thrombocytopenia,while ITP was mostly severe thrombocytopenia.（2）PAT patients are generally in good condition,with mild thrombocytopenia,short hospital stay and good maternal and fetal outcomes.（3）The mode of delivery needs to be analyzed individually according to the obstetric situation,and the platelet count can not be used as the indication of cesarean section.Vaginal trial delivery can be carried out without absolute contraindication of vaginal delivery.（4）The treatment principle is to find the etiology,evaluate the risk,select the appropriate mode of delivery and terminate the pregnancy in time.The most common idiopathic thrombocytopenia of pregnancy usually requires close monitoring without special clinical intervention.（5）The neonatal outcome of pregnancy complicated with thrombocytopenia is good,and hemorrhagic events are rare.