| Objective The clinical features of pregnant women with thrombocytopenia and their effects on maternal and infant adverse outcomes were retrospectively analyzed,and the risk factors for postpartum hemorrhage in singleton women with pregnancy complicated with thrombocytopenia were explored exploratorily.Methods Collect the clinical data of 286 pregnant women who underwent routine prenatal examination and successful delivery in the Second People’s Hospital from January 2017 to December 2021 and met the inclusion criteria for pregnancy with thrombocytopenia,collated basic data,such as age,height,weight,body mass index(BMI),pregnancy and delivery,gestational week,hospital stay,recorded the minimum platelet count during pregnancy,the last blood routine(platelet count and hemoglobin count)before delivery,and the first repeat blood routine(platelet count and hemoglobin count)after delivery,Laboratory indicators such as the last coagulation routine before delivery,bleeding gums,pregnancy complications and complications,and final maternal and infant outcomes.Firstly,the causes of thrombocytopenia during pregnancy were analyzed,and secondly,according to the minimum platelet count during pregnancy,they were divided into mild thrombocytopenia group(50-100×10~9/L),moderate thrombocytopenia group(30-49×10~9/L),and severe thrombocytopenia group(<30×10~9/L).Finally,SPSS26.0 software was used to analyze and compare the general clinical features,related laboratory indicators and maternal and infant outcomes of the three groups of pregnant women.At the same time,according to whether postpartum hemorrhage occurred,pregnant women with thrombocytopenia were divided into postpartum hemorrhage group and non-postpartum hemorrhage group,and the risk factors related to postpartum hemorrhage in pregnant women with thrombocytopenia were explored.Results1.Analysis of the etiology of thrombocytopenia in pregnant women complicated by thrombocytopenia:(1)Pregnancy-specific causes:gestational thrombocytopenia(GT)is the most common,with a total of 208 cases,accounting for 72.7%of the entire thrombocytopenia causes.This was followed by pregnancy-induced hypertension(PIH)associated with hypertensive diseases of pregnancy,with a total of 31 cases(including 12 cases of HELLP syndrome and 19 cases of preeclampsia),accounting for about 10.8%of the causes of thrombocytopenia.There were 16 cases of acute fatty liver disease during pregnancy,accounting for 5.6%of the causes of thrombocytopenia.(2)Causes unrelated to pregnancy:12 cases of primary immune thrombocytopenia(ITP),accounting for 4.2%of the causes of thrombocytopenia.Antiphospholipid syndrome was 2 cases,accounting for 0.7%of the causes of thrombocytopenia.There were 17other rare causes(8 cases of aplastic anemia and 9 cases of systemic lupus erythematosus),accounting for about 5.9%of the causes of thrombocytopenia.2.Thrombocytopenia severity group:190 cases(mild thrombocytopenia group),75cases(moderate thrombocytopenia group),21 cases(severe thrombocytopenia group).3.Analysis of clinical data of three groups of thrombocytopenic pregnant women:(1)General clinical data:the three groups were compared with age,BMI,gestational age,gestational time,and childbirth,and the differences were not statistically significant,and the baseline data of the three groups were balanced and comparable.(2)The three groups of prenatal related laboratory indicators:the lowest platelet count during pregnancy[91(85-97),43(37-47),22(20-28)]was compared with a statistically significant difference(P<0.01);Prenatal platelet count was statistically significant(P<0.01)between mild group and moderate and severe group([96(90-101)],[75(66-85)],[66(47.5-77.5)]),and not statistically significant(P>0.05)between moderate and severe groups.Prenatal hemoglobin was statistically significant between mild and severe groups([124(118-129)])(P<0.05);prenatal hemoglobin levels in the severe group were lower than those in the moderate group([122(117-128)]),but not statistically significant(P>0.05),;P and there was no significant difference between the three groups of T,APTT,FBG,and D-D coagulation routine(P>0.05).(3)Comparison of platelet count difference before and after delivery of the three groups:The platelet count after delivery was compared with the platelet count before delivery,and whether there was any change in the difference between platelet count before and after childbirth was analyzed,it was concluded that the platelet count after delivery in the three groups was higher than that before delivery,and the difference was statistically significant(P<0.05).(4)Maternal outcomes:the hospital stay of pregnant women in the mild group was significantly shorter than that in the moderate and severe groups,and the difference between the two groups was statistically significant(P<0.01);There was no significant difference between the moderate and severe groups.The selection of caesarean section for termination of pregnancy was significantly higher in the severe group than in the other two groups,with a statistically significant difference(P<0.05).In terms of postpartum hemorrhage,there was a significant difference between the mild group and the moderate and severe group(P<0.05).(5)Neonatal outcomes:the risk of neonatal conversion to NICU in the severe thrombocytopenia group was higher than that in the mild thrombocytopenia group(23.8%:8.6%)(P<0.05);although the rate of neonatal to NICU in the severe group was higher than that in the moderate group,there was no significant difference between the two groups(23.8%:17.9%)(P>0.05).There were no significant differences in neonatal weight,body length and birth Apgar score(P>0.05).4.Treatment during pregnancy in three groups:152 cases were untreated(platelet count was closely monitored during pregnancy),120 cases in the mild group,23 cases in the moderate group,and 9 cases in the severe group;A total of 105 cases were treated orally with general drugs(weixuening,shengxuening,peanut clothing),70 cases in the mild group,32 cases in the moderate group,and 3 cases in the severe group;A total of12 cases were treated with glucocorticoids and/or gamma globulin pulse,11 in the moderate group and 1 in the severe group.Platelet transfusion was 7 cases,3 in the moderate group and 4 in the severe group;A total of 10 cases were transfused with glucocorticoids and/or gamma globulin combined with platelet transfusion,and 5 cases were in the moderate and severe groups.5.Risk factors for postpartum hemorrhage in pregnant women with thrombocytopenia in pregnancy:(1)286 pregnant women with thrombocytopenia were divided into postpartum hemorrhage group(70 cases)and non-postpartum hemorrhage group(216 cases)according to whether they had postpartum hemorrhage.(2)Univariate analysis showed that hypertensive diseases during pregnancy,severity of thrombocytopenia,and hemoglobin before delivery were the main risk factors affecting postpartum hemorrhage in pregnant women with thrombocytopenia(P<0.05).(3)The results of binary logistic regression analysis showed that the severity of thrombocytopenia and pre-delivery hemoglobin were risk factors for postpartum hemorrhage in pregnant women with thrombocytopenia(OR:1.009,95CI:1.004-1.058,P<0.05;OR:1.031,95%CI:1.378-1.084,P<0.05).Conclusions1.Causes of pregnancy with thrombocytopenia:thrombocytopenia during pregnancy is the most important cause,followed by thrombocytopenia associated with hypertensive diseases during pregnancy,primary immune thrombocytopenia in pregnancy,and finally some other rare causes,such as antiphospholipid syndrome,systemic lupus erythematosus,etc.2.Maternal and infant outcomes:with the more severe thrombocytopenia,the longer the maternal hospital stay,the higher the incidence of postpartum hemorrhage,the higher the proportion of pregnancy terminated by cesarean section,and the corresponding risk of neonatal admission to the NICU.3.Platelet count before and after delivery:platelet count after delivery is significantly higher than before delivery,and considering termination of pregnancy is a necessary means to improve further thrombocytopenia.4.Treatment during pregnancy:mainly according to the severity and etiology of thrombocytopenia for targeted treatment,mainly observation,most of the general drug oral treatment,severe choice of glucocorticoids and gamma globulin shock,and even platelet transfusion therapy.5.Among the influencing factors of postpartum bleeding in pregnant women with thrombocytopenia in pregnancy:thrombocytopenia severity and hemoglobin reduction are two independent risk factors. |
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