Singhal Seema, Roy Kallol Kumar, Kumar Sunesh, Meena Jyoti, Bharti Juhi, Shekhar Bhawani
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
Natl Med J India. 2018 May-Jun;31(3):146-148. doi: 10.4103/0970-258X.255756.
Pregnancy with massive splenomegaly is a rare entity and is associated with increased risk to both mother and foetus. There is paucity of studies in the literature to guide clinicians for the management of this condition.
We reviewed the course of pregnancy, maternal and foetal outcomes of 5 pregnant women with massive splenomegaly who were managed in our unit during 2015-16.
All 5 women had anaemia and thrombocytopenia, and had different causes for splenomegaly. One patient had chronic malaria, 2 had portal hypertension with cirrhosis and the remaining 2 had non-cirrhotic portal hypertension. Life-threatening complications were present in 2 patients; one of them had severe pre-eclampsia complicated by pulmonary oedema, cardiac arrest and the other patient developed spontaneous bacterial peritonitis. Intrauterine growth restriction and meconium-stained liquor were the most common perinatal complications. Two patients had vaginal delivery and 3 required emergency caesarean section. Postpartum haemorrhage was present in 2, and the hospital stay was prolonged in all the patients. All mothers and babies were discharged in a satisfactory condition.
Pregnancy with massive splenomegaly poses a challenge because of diverse aetiology and potentially adverse outcomes. Multidisciplinary care in a tertiary centre can help optimize the outcome.
合并巨大脾肿大的妊娠是一种罕见情况，与母亲和胎儿的风险增加相关。文献中缺乏指导临床医生管理这种情况的研究。
我们回顾了2015 - 16年在我们科室接受治疗的5例合并巨大脾肿大孕妇的妊娠过程、母婴结局。
所有5名女性均有贫血和血小板减少症，脾肿大的原因各不相同。1例患者患有慢性疟疾，2例患有肝硬化伴门静脉高压，其余2例患有非肝硬化性门静脉高压。2例患者出现危及生命的并发症；其中1例患有重度子痫前期并伴有肺水肿、心脏骤停，另1例患者发生自发性细菌性腹膜炎。胎儿生长受限和羊水胎粪污染是最常见的围产期并发症。2例患者经阴道分娩，3例需要紧急剖宫产。2例出现产后出血，所有患者住院时间均延长。所有母婴均顺利出院。
合并巨大脾肿大的妊娠由于病因多样和潜在的不良结局而构成挑战。三级中心的多学科护理有助于优化结局。
