Clinical Analysis And Maternal And Neonatal Outcomes Of Pregnancy Complicated With Thrombocytopenia

Objective:To analyse the etiology,mode of delivery,pregnancy outcome,laboratory indicators and treatment options in patients with thrombocytopenia in pregnancy,to discuss the management of pregnancy and delivery in thrombocytopenic women with different etiologies,and to provide guidance for the choice of treatment options to optimise delivery and reduce the occurrence of adverse outcomes.Methods:The clinical data of 435 patients with thrombocytopenia in pregnancy admitted to the First Hospital of Soochow University and terminated in our hospital from January 2018 to December 2022 were retrospectively analyzed and divided into three groups according to the degree of thrombocytopenia:mild group:50X109/L ≤platelet count<100×109/L.The moderate group:30×109/L≤platelet count<50×109/L.The severe group:platelet count<30×109/L.The thrombocytopenia was divided into four groups according to the different causes of thrombocytopenia:thrombocytopenia of pregnancy(GT)group,immune thrombocytopenic purpura(ITP)group,hypertensive disorders of pregnancy(HDCP)group,other groups(including myelodysplastic syndromes(MDS),aplastic anemia(AA)group,and thrombocytopenia in pregnancy(MDS)group,aplastic anaemia(AA),acute leukaemia,thrombotic thrombocytopenic purpura(TTP),Evans syndrome,thrombocytopenia,severe granulocyte deficiency,systemic lupus erythematosus(SLE),dry syndrome,dermatomyositis,etc.).One hundred and six singleton,low-risk healthy pregnant women who had regular maternity examinations and terminated their pregnancies at our hospital during the same period were selected as the control group.A number of data such as pregnancy status,laboratory indicators and delivery outcome were recorded and analysed.The thrombocytopenic patients were divided into unspecified treatment group,glucocorticoid treatment alone group and glucocorticoid combined with gammaglobulin treatment group according to the drug treatment regimen.The relationship between treatment regimen and pregnancy outcome was analysed using univariate and multi factorial logistic regression.Results:1.There were 435 patients with thrombocytopenia in pregnancy,of whom 424 had a single live birth and 11 had an induced or stillbirth.There were no statistically significant differences in age,number of pregnancies and days in hospital between the different degree groups.The etiology of patients in the mild and moderate groups was mostly GT,while the etiology of patients in the severe group was mostly ITP.2.Mode of delivery:The cesarean delivery rate in the severe group(87.7%)was significantly higher than that in the mild group(52.6%)and the moderate group(58.5%),and the difference was statistically significant(P<0.001).The cesarean delivery rate in the GT group(54.5%)was significantly lower than that in the HDCP group(85%),and the difference was statistically significant(P<0.05);the differences in cesarean delivery rates between the other etiology groups were not statistically significant(P>0.05).3.Bleeding:The rate of antenatal bleeding was significantly lower in the mild group(12.3%)than in the moderate group(46.3%)and the severe group(64.9%),with a statistically significant difference(P<0.001).The rate of antenatal bleeding was significantly higher in the ITP group(50%)than in the GT group(23.2%)and the HDCP group(15%),with a statistically significant difference(P<0.001).There was no statistically significant difference in the rate of postpartum haemorrhage and the amount of postpartum haemorrhage in each platelet severity group(P>0.05).The perinatal platelet transfusion rate was significantly higher in the severe group(89.5%)than in the mild group(5.3%)and the moderate group(39%),with a statistically significant difference(P<0.001).There was no statistically significant difference in the rate of postpartum haemorrhage among the etiological groups(P>0.05).The rate of perinatal platelet transfusion was significantly higher in the ITP group(68.5%)than in the GT group(11.6%)and HDCP group(30%),with a statistically significant difference.Comparing postpartum bleeding with mode of delivery,the difference was not statistically significant(P>0.05).4.Neonatal outcome:Neonatal gestational age(36.22±0.23 weeks)and neonatal weight(2769.12±68.19 g)were significantly lower in the severe group than in the mild group,and the difference was statistically significant(P<0.05).The preterm birth rate(49.1%)and transfer rate(56.1%)in the severe group were significantly higher than those in the mild and moderate groups,with statistically significant differences(P<0.05).The preterm birth rate,transfer rate and low weight rate in the HDCP group were all higher than those in the other groups,with statistically significant differences(P<0.001).5.Coagulation status:Patients in the ITP and GT groups had prolonged R and K values and reduced alpha angle,MA and CI values in the TEG examination,with statistically significant differences compared to the normal pregnancy group(P<0.05),and GT was lighter than ITP.The degree of thrombocytopenia was independent of coagulation factors,and platelet aggregation function decreased with the decrease in platelet count.6.Treatment modality:Combined medication and untreated groups in ITP patients may increase the risk of perinatal platelet transfusion compared to the hormone alone group,with a statistically significant difference(P<0.05)in the platelet treatment upsurge value in the combined medication group compared to the hormone alone group.platelet count at delivery was lower in the combined medication group(50.90 x 109/L)than in the untreated and hormone alone groups in GT patients,and the perinatal platelet transfusion rate(60%)was higher than the other two groups,with statistically significant differences(P<0.05).Conclusion:1.The causes of thrombocytopenia in pregnancy include GT,ITP,hypertensive diseases during pregnancy and diseases related to the immune system,among which GT is the most common.The etiology and pathogenesis of some diseases are unclear.The positive rate of platelet membrane glycoprotein specific antibody in ITP patients is significantly higher than that in GT patients,which may be meaningful for the differentiation of GT and ITP.2.Patients with mild to moderate thrombocytopenia were mostly diagnosed as GT,with good maternal and infant outcomes;Severe patients are mostly diagnosed with ITP and need to strengthen intervention during pregnancy.Most patients have fewer hemorrhagic events and a fair prognosis.Neonatal adverse outcomes of hypertensive diseases during pregnancy are more,which are mainly related to the primary disease rather than thrombocytopenia,so the treatment of the primary disease should be paid attention to.3.Severe postpartum bleeding in patients with pregnancy and thrombocytopenia is generally not much,which may be related to the basic normal blood coagulation.The coagulation status of patients with thrombocytopenia was detected by TEG,and some patients with severe GT and ITP showed wasting hypocoagulation,requiring timely intervention.4.The combination regimen of hormone and propyl bulb may be superior to the regimen of hormone alone in improving platelet count.For patients with severe ITP thrombocytopenia,combination medication or platelet infusion can be given to improve platelet levels.Some mild and moderate patients may not need hormone or propyl therapy and only platelet infusion can be given.There was no significant benefit in platelet count increase and maternal and infant outcome in GT patients treated with hormone and propyl bulb.Individualized treatment should be given according to different etiologies to avoid overtreatment.