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[重症监护中重度子痫前期-子痫 HELLP 综合征血小板计数低时的孕产妇及围产期手术并发症]

[Maternal and perinatal surgical complications in low platelet count for HELLP syndrome in severe preeclampsia-eclampsia in intensive care].

作者信息

Basavilvazo Rodríguez Antonia, Pacheco Pérez Claudia, Lemus Rocha Roberto, Martínez Pérez José Ma, Martínez Martínez Armando, Hernández-Valencia Marcelino

机构信息

Hospital de Ginecología y Obstetricia No. 3, Centro Médico Nacional La Raza y Unidad de Investigación Médica en Enfermedades Endocrinas, Centro Médico Nacional S-XXI, IMSS, México, D.F.

出版信息

Ginecol Obstet Mex. 2003 Aug;71:379-86.

Abstract

The preeclampsia is the first cause of maternal morbility, with increase in the obstetric complications when it is associated to HELLP syndrome, for the low platelets that even involves to the neonate. This study was carried out in the patients accepted in the intensive Adults Cares Unit in the period of one year, surgical complications and the perinatal results were determined in women with low platelet count for HELLP syndrome in preeclampsia-eclampsia. Three groups were formed according to the platelets account and then were analyzed using chi square to determine association among these groups of patients, as well as mean and standard deviation (M +/- DE) to describe results. Forty patients were studied with low platelets by HELLP syndrome in preeclampsia-eclampsia, where the distribution for the group with platelets < 50,000 were 12 patients (30%), in the group among 51,000-100,000 of 18 cases (45%), and of 101,000-150,000 were of 10 cases (25%). The mean of gestas was of 2.3 +/- 1.2, more frequent delivery was for cesarean section in 39 cases (97.5%) and a single case for vaginal via (2.5%), a maternal death was presented (8.3%). The surgical reintervention was observed with more frequency in the group of < 50,000 platelets, the most frequent cause in these reinterventions was the hipovolemic shock. Also in this group the perinatal mortality was presented in 3 cases (25%) and the asphyxia at the birth with Apgar < 6 was presented in 5 cases (41.7%). A bigger morbility was observed inversely proportional to the account platelets, being the renal failure the cause most frequent of this morbility in the three groups. The low platelets account contribute in a direct way in the obstetric complications, since there are more surgical reinterventions, with bled in the transsurgical and increase in the days of intrahospitalary stay. Also with smaller account platelet, there are bigger prematural index, asphyxia and perinatal mortality in the newborn of mothers with HELLP syndrome.

摘要

子痫前期是孕产妇发病的首要原因,当与HELLP综合征相关时,产科并发症会增加,因为血小板减少甚至会影响新生儿。本研究对一年内入住成人重症监护病房的患者进行,确定了子痫前期-子痫患者因HELLP综合征血小板计数低时的手术并发症和围产期结局。根据血小板计数分为三组,然后使用卡方检验分析以确定这些患者组之间的关联,并使用均值和标准差(M±DE)来描述结果。对40例子痫前期-子痫患者因HELLP综合征血小板计数低进行了研究,其中血小板<50,000的组有12例(30%),51,000 - 100,000的组有18例(45%),101,000 - 150,000的组有10例(25%)。孕周均值为2.3±1.2,剖宫产分娩最常见,共39例(97.5%),经阴道分娩1例(2.5%),有1例孕产妇死亡(8.3%)。血小板<50,000的组手术再次干预更频繁,这些再次干预中最常见的原因是低血容量性休克。该组还出现3例围产期死亡(25%),5例出生时窒息且阿氏评分<6(41.7%)。观察到发病率与血小板计数成反比,肾衰竭是三组中这种发病率最常见的原因。血小板计数低直接导致产科并发症增加,因为手术再次干预更多,手术中有出血且住院天数增加。而且血小板计数越低,HELLP综合征母亲的新生儿早产指数、窒息和围产期死亡率越高。

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