Copplestone J A
Derriford Hospital, Plymouth, Devon.
Q J Med. 1992 Aug;84(304):593-601.
During pregnancy some women develop unexplained thrombocytopenia (gestational thrombocytopenia). Previous studies have detected abnormal platelet antibodies, suggesting an autoimmune aetiology. To determine whether gestational thrombocytopenia is associated with increased maternal bleeding or adversely affects the fetus, 31 pregnant women with asymptomatic thrombocytopenia were compared with 12 women with thrombocytopenia associated with pre-eclampsia and 34 normal pregnant controls. There was no increase in maternal bleeding in those with asymptomatic thrombocytopenia compared with the normal controls, but pre-eclamptic women experienced more bleeding (mean difference 181 ml, 95 per cent confidence limits 50-312 ml, p < 0.01). There was no difference in the mean weights of the babies or placenta, nor in the APGAR scores between infants born to controls and those with asymptomatic thrombocytopenia. Cord blood platelet levels were measured in 26 women with asymptomatic thrombocytopenia and were normal in 25 and mildly reduced in one. Thus measures used for the treatment and delivery of pregnancies complicated by autoimmune thrombocytopenia are not indicated in gestational thrombocytopenia. Pregnant women should not be considered thrombocytopenic unless the platelet count has fallen below 120 x 10(9)/l.
在孕期，一些女性会出现不明原因的血小板减少症（妊娠性血小板减少症）。以往的研究检测到异常的血小板抗体，提示自身免疫病因。为了确定妊娠性血小板减少症是否与母体出血增加相关或对胎儿产生不利影响，将31例无症状血小板减少症孕妇与12例与先兆子痫相关的血小板减少症孕妇以及34例正常孕妇进行了比较。与正常对照组相比，无症状血小板减少症孕妇的母体出血并未增加，但先兆子痫孕妇出血更多（平均差异181ml，95%置信区间50 - 312ml，p < 0.01）。对照组和无症状血小板减少症孕妇所生婴儿的平均体重、胎盘重量以及阿氏评分均无差异。对26例无症状血小板减少症孕妇的脐血血小板水平进行了检测，其中25例正常，1例轻度降低。因此，妊娠性血小板减少症无需采用用于治疗和处理合并自身免疫性血小板减少症妊娠的措施。除非血小板计数降至120×10⁹/L以下，否则孕妇不应被视为血小板减少。
