Chames Mark C, Haddad Bassam, Barton John R, Livingston Jeffrey C, Sibai Baha M
Department of Obstetrics and Gynecology, University of Cincinnati, OH 45267-0526, USA.
Am J Obstet Gynecol. 2003 Jun;188(6):1504-7; discussion 1507-8. doi: 10.1067/mob.2003.383.
The purpose of this study was to describe subsequent pregnancy outcome in women with a history of hemolysis, elevated liver enzymes, and low platelet count syndrome for which delivery occurred at < or = 28 weeks of gestation during the index pregnancy.
A descriptive report of women with previous hemolysis, elevated liver enzymes, and low platelet count syndrome who were delivered between August 1984 and July 1998 at the E.H. Crump Women's Hospital (Memphis, Tenn) and between March 1994 and July 1998 at the Central Baptist Hospital (Lexington, Ky). To have adequate time to study subsequent pregnancy outcome, only patients who were delivered >2 years before the analysis were included. Medical records of the index pregnancy and subsequent outcomes were available for review.
Adequate follow-up data were available in 69 patients; the median duration of follow-up was 5 years (range: 2-14 years). There were 76 subsequent pregnancies among 48 women, of which 62 pregnancies (82%) progressed beyond 20 weeks of gestation. Preeclampsia developed in 34 of 62 subsequent pregnancies (55%). Recurrent hemolysis, elevated liver enzymes, and low platelet count syndrome developed in 4 of these pregnancies (6%), and abruptio placentae developed in 3 of these pregnancies (5%). There were no cases of eclampsia in our population. Delivery before 37 weeks of gestation occurred in 33 of the cases (53%), and 17 of the newborn infants (27%) were small for gestational age (<10th percentile). The perinatal mortality rate was 11%.
Patients with a history of hemolysis, elevated liver enzymes, and low platelet count syndrome at < or = 28 weeks of gestation during the index pregnancy are at increased risk for obstetric complications in subsequent pregnancies. Overall, however, the rate of recurrent hemolysis, elevated liver enzymes, and low platelet count syndrome is only 6%.
本研究旨在描述在本次妊娠期间妊娠<或=28周分娩的有溶血、肝酶升高及血小板减少综合征病史的女性的后续妊娠结局。
对1984年8月至1998年7月在田纳西州孟菲斯市E.H.克伦普妇女医院以及1994年3月至1998年7月在肯塔基州列克星敦市中央浸信会医院分娩的既往有溶血、肝酶升高及血小板减少综合征的女性进行描述性报告。为有足够时间研究后续妊娠结局，仅纳入在分析前2年以上分娩的患者。可查阅本次妊娠及后续结局的病历。
69例患者有充分的随访数据；随访时间中位数为5年（范围：2 - 14年）。48名女性中有76次后续妊娠，其中62次妊娠（82%）孕周进展至20周以上。62次后续妊娠中有34次（55%）发生子痫前期。这些妊娠中有4次（6%）复发溶血、肝酶升高及血小板减少综合征，3次（5%）发生胎盘早剥。我们的研究人群中无子痫病例。33例（53%）在妊娠37周前分娩，17例新生儿（27%）小于胎龄（<第10百分位数）。围产儿死亡率为11%。
在本次妊娠期间妊娠<或=28周时有溶血、肝酶升高及血小板减少综合征病史的患者，后续妊娠发生产科并发症的风险增加。然而，总体而言，复发溶血、肝酶升高及血小板减少综合征的发生率仅为6%。
