Pregnancy Outcome With Thrombocytopenia

Objectives:To study the causes of pregnant women with thrombocytopenia,the choice of delivery mode and its influence on maternal and child outcomes,in order to provide scientific basis for pregnant women with thrombocytopenia to choose appropriate delivery mode,reduce cesarean section rate and improve adverse outcomes of maternal and child.methods:The clinical data of puerperas and newborns in the first affiliated hospital of obstetrics of kunming medical university were retrospectively analyzed on January 1,2008 solstice and December 31,2017.According to the diagnostic criteria of platelet count in pregnancy at least twice<100 109/L,400 cases of pregnant women with thrombocytopenia who gave birth at or above 28 weeks were included.The pregnant women with thrombocytopenia were divided into three groups according to the different delivery modes,and the matermal and child outcomes of different delivery modes were analyzed and compared.In addition to 400 cases of pregnancy with thrombocytopenia,7 cases of twins were excluded.The rest were selected as the appropriate control group from the parturients with normal platelets according to the case-control study method of 1:2 ratio.The matching conditions of case control were:delivery age 1 years,delivery gestational week and delivery date 1 week.Univariate and multivariate Logistic regression analysis and intergroup comparison were used for the case group and the control group to analyze the related factors affecting pregnancy with thrombocytopenia and the impact of pregnancy with thrombocytopenia on maternal and child outcomes.Results:From January l,2008 to December 31,2017,45,332 women gave birth in the first affiliated hospital of kunming medical university,including 400 cases of pregnant women with thrombocytopenia who gave birth at or above 28 weeks.The incidence of pregnant women with thrombocytopenia was 0.9%,and the annual incidence of thrombocytopenia was close to 100%.PT has many causes,with thrombocytopenia during pregnancy the most common.Among the 400 cases of PTC,168 cases were delivered by cesarean section,and the cesarean section rate was 42%.Pregnancy with thrombocytopenia total cesarean delivery rate.cesarean section rate for the first time,repeated cesarean section rate correlation analysis is made on total cesarean delivery rate(r=0.625,P=0.027),the first cesarean section rate(r=0.826,P=0.003)and negatively correlated with year,repeated cesarean section rate(r=0.568,P=0.043)was positively related with year,shows that from 2008 to 2017,from pregnancy with thrombocytopenia women total cesarean delivery rate,cesarean section rate assumes the declining trend year by year,for the first time and repeat cesarean delivery rate is on the rise.There were 168 cases of pregnant women with thrombocytopenia who were delivered by cesarean section,among which only 14 cases,accounting for 8%,were delivered by cesarean section due to pregnancy with thrombocytopenia.The 154 cases of cesarean section women not only had thrombocytopenia,but also combined with other cesarean section indications.From 2008 to 2017.cesarean section due only to pregnancy with thrombocytopenia was on the decline.Pregnancy with thrombocytopenia,compares natural labor and after cesarean section delivery postpartum maternal blood loss,incidence of postpartum hemorrhage or 500 ml,blood transfusion treatment,the mother turned the NICU,total hospitalization days,postpartum hospitalization days,hospitalization expenses,postpartum fever.neonatal NICU,neonatal NICU only observe,neonatal platelet count<100 x 109/L difference was statistically significant(P<0.05):Only postpartum fever was statistically significant(P=0.046).There were statistically significant differences between cesarean delivery and forceps delivery in terms of postpartum hospital transfer days,total hospital stay days,and hospital costs(P<0.05).All cases of neonatal intracranial hemorrhage were preterm.Cesarean delivery did not reduce the incidence of neonatal intracranial hemorrhage,nor significantly improved the adverse outcome of neonates.There were no statistically significant differences between PT delivery methods in the lowest platelet count during pregnancy and the median prenatal platelet count(P>0.05).Univariate and multivariate logistic regression analysis of the matched case group and control group s:howed that viral hepatitis(OR=1.733),autoimmune diseases(OR=1.733)and hypertension(OR=6.702)were independent risk factors for pregnancy with thrombocytopenia(P<0).05).There was no statistically significant difference in delivery modes between the matched case group and the control group(P>0.05).Case group and control group comparison of postpartum haemorrhage amount and rate of postpartum hemorrhage,postpartum hemorrhage diagnostic criteria:vaginal delivery or 500 ml,cesarean section 1000 ml)or higher,blood transfusion treatment,the total hospitalization days,the actual number of days in hospital,hospital cost,postpartum fever,neonatal birth weight,NICU occupancy,NICU should treatment,newborn hemorrhage,neonatal platelet count<100 x 109/L difference was statistically significant(P<0.05);However,it is worth noting that the incidence of postpartum hemorrhage 1500ml and neonatal intracranial hemorrhage was not statistically significant between the case group and the control group.Conclusion:1.According to the diagnostic criteria of platelet count 100 109/L during pregnancy,the incidence of PT was about 1%,and the annual incidence was relatively stable.PT has many causes,with thrombocytopenia during pregnancy the most common.2.Although the PT repeated cesarean section rate showed an upward trend,the overall cesarean section rate and the first cesarean section rate of PT showed a downward trend.The number of cases with pregnancy associated with thrombocytopenia as an indication of cesarean section has decreased year by year,indicating that clinicians’ views on the choice of thrombocytopenia delivery mode are changing,and PT transvaginal delivery is being recognized by more and more obstetrical clinicians.3.There was no significant difference in the incidence of postpartum hemorrhage and intracranial hemorrhage among the parturients with different PT delivery methods.Due to large surgical wounds,PT delivered by cesarean section resulted in a large amount of postpartum blood loss,postpartum fever,hospitalization costs and increased hospitalization days.The choice of PT delivery mode is independent of maternal platelet count and should be solely determined by obstetric conditions.4.Independent risk factors for pregnancy with thrombocytopenia,including viral hepatitis,hypertension-related diseases and autoimmune diseases.Platelet count should be closely monitored during pregnancy complicated with the above diseases,and thrombocytopenia should be detected as early as possible,so as to deternine the progress of the disease through platelet count,so as to make correct treatment in time and reduce adverse outcomes of mothers and children.5.The incidence of postpartum hemorrhage,transfusion therapy,postpartum fever.hospitalization days and hospitalization costs of pregnant women with thrombocytopenia during pregnancy were higher than those with normal platelets.There was no significant difference in the incidence of intracranial hemorrhage and postpartum massive hemorrhage between PT neonates and normal pregnant women with platelets during pregnancy,regardless of the gestational week,delivery date and delivery age.