Determination Of Platelet Change Trend In Pregnant Patients With Thrombocytopenia

Objective:In this study,the etiology of pregnant women with thrombocytopenia was analyzed.Then the patients were divided into groups according to the degree of thrombocytopenia,and the distribution of each cause in different degrees of thrombocytopenia,as well as the treatment for the cause during pregnancy and the maternal and fetal outcomes of patients with different degrees of thrombocytopenia were studied.Finally,the fluctuation of platelet related indicators in patients with different degrees of thrombocytopenia during pregnancy was analyzed to determine the reasonable monitoring frequency,so as to better guide clinical practice.Methods:The clinical data of 189 pregnant women with thrombocytopenia who delivered in the Second Affiliated Hospital of Dalian Medical University from January 2017 to December2022 were collected through electronic medical records.Those with 50×10⁹/L≤PLT<100×10⁹/L were classified as mild group,those with 30×10⁹/L≤PLT<50×10⁹/L were classified as moderate group,and those with PLT<30×10⁹/L were classified as severe group.Demographic information（age,BMI,gravidity,parity）,clinical data（treatment,hospitalization time,delivery gestational age,delivery mode,cesarean section indication,anesthesia mode,delivery bleeding volume,premature delivery rate,neonatal Apgar score,neonatal birth weight,transfer rate,postpartum hemorrhage rate）and laboratory indicators（the lowest value of platelet during pregnancy,early pregnancy and middle pregnancy）were collected Blood routine test,blood routine test of late stage,blood routine test of 24 hours before delivery,blood routine test of 24 hours after delivery,blood routine test of 42 days after delivery).The database was established by Excel,and SPSS25.0 statistical software was used for statistical analysis.The regression estimation method was used to impute missing data and calculate the rate of missing data.The changes of platelet count and related indicators in different gestational weeks were analyzed and plotted by nested box plot.Results:1.Etiology analysis of pregnancy complicated with thrombocytopenia:PAT accounted for 42.32%,ITP for 14.81%,HDCP for 24.33%,CTD for 3.17%,SLE for4.76%,APS for 1.59%,ICP for 2.12%,AA for 1.06%,infection for 1.59%,TTP for 0.53%,blood disease for 1.06%.The unexplained group accounted for 2.65%.2.The relationship between the degree of thrombocytopenia and etiology:the proportion of mild thrombocytopenia was the highest,followed by moderate thrombocytopenia,and severe thrombocytopenia was the least.Thrombocytopenia was mild in PAT group and HDCP group,but moderate in ITP group.3.Demographic data:there was no significant difference in maternal age,BMI,gravidity and parity（P>0.05）.4.Treatment:the mild group had the highest general treatment during pregnancy,accounting for 82.4%The proportion of blood products transfusion in moderate group and severe group was the highest,accounting for 32.1%and 65.4%,respectively.There was no significant difference in hydroxychloroquine treatment and antispasmodic antihypertensive treatment in pregnant women（P>0.05）.There were significant differences in general treatment,hormone treatment,immunoglobulin treatment,recombinant human thrombopoietin treatment,and transfusion of blood products in pregnant women（P<0.05）.5.The indicators of delivery and maternal and child outcomes:there was no significant difference in the gestational age of delivery,delivery mode,anesthesia mode,blood loss during labor,Apgar score of newborns,birth weight of newborns,postpartum hemorrhage rate of pregnant women,and neonatal transfer rate（P>0.05）There were statistically significant differences in the length of hospital stay of pregnant women,the indications of cesarean section of pregnant women,and the rate of preterm birth of newborns（P<0.05）.6.Laboratory indicators:28-36⁺⁶ weeks of gestation（WBC,MPV,PDW）,37 weeks of gestation-before delivery（WBC,Hb,PCV,PCT,PDW）,24 hours before delivery（Hb,PCT,PDW,APTT,TT,Fbg,PT）,within 24 hours after delivery（WBC,Hb,PCV,PCT,PDW）,and delivery After 42 days（WBC,RBC,Hb,PCV,PLT,PCT,MPV,PDW）,there was no significant difference（P>0.05）.There were statistically significant differences in16 variables including the lowest platelet count during pregnancy,28-36⁺⁶ weeks of pregnancy（RBC,Hb,PCV,PLT,PCT）,37 weeks of pregnancy-before delivery（RBC,PLT,PCT）,24 hours before delivery（RBC,RBC,PCV,PLT,MPV）,and 24 hours after delivery（WBC,PLT,MPV）（P<0.05）.7.The change trend of platelet and platelet hematocrit:the mild group showed a gradual decrease trend during pregnancy and quickly returned to normal after delivery,the moderate group showed little change in the first and second trimester of pregnancy,and the severe group fluctuated greatly throughout pregnancy and recovered the slowest after delivery.8.The change trend of platelet volume and platelet distribution width:the mild group increased gradually in the first and second trimester,and decreased gradually in the third trimester;The change trend of moderate group and mild group was similar.The severe group varied greatly with the progression of gestational age,and in the postpartum period,the basic volume distribution was consistent among the three groups.9.The change trend of platelet crit was similar to that of platelet,and the change trend of platelet volume was similar to that of platelet distribution width,which needed further study with large samples.Conclusion:1.The causes of thrombocytopenia in pregnancy include PAT,ITP,thrombocytopenia associated with hypertensive disorders of pregnancy,and immune system diseases,among which PAT is the most common.2.PAT and HDCP were the most common causes of mild thrombocytopenia,while ITP was the most common causes of moderate and severe thrombocytopenia.3.Mild pregnancy with thrombocytopenia does not need special treatment during pregnancy,only need general symptomatic treatment,without excessive intervention,to avoid excessive medical treatment.Thrombocytopenia in moderate pregnancy is mainly caused by transfusion of blood products and hormone therapy.Severe pregnancy complicated with thrombocytopenia is mainly transfusion of blood products,which needs to be strengthened monitoring and intervention during pregnancy,and given corresponding treatment according to the primary cause.4.According to the results of this study,we can reduce the frequency of testing for patients with mild and moderate thrombocytopenia during pregnancy,and closely monitor the condition of patients with severe thrombocytopenia,and increase the frequency of testing during pregnancy.The recommended testing scheme is:the frequency of blood routine testing for patients with mild thrombocytopenia is:Blood routine tests were performed at 28-35⁺⁶ weeks of gestation and 36-38⁺⁶ weeks of gestation.Patients with moderate thrombocytopenia can reduce the frequency of blood routine testing,and the testing protocol is the same as that of mild thrombocytopenia.Patients with severe thrombocytopenia should have routine blood tests performed at each prenatal visit.