Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.
Referral Center of Pregnancy Complicated with Hematological Diseases, Beijing Municipal Health of Commission, Beijing, China.
Platelets. 2024 Dec;35(1):2380366. doi: 10.1080/09537104.2024.2380366. Epub 2024 Aug 1.
Clinical research data showed a series of adverse events in the delivery period of primary immune thrombocytopenia (ITP) patients, including high cesarean section rate. Consensus report proposed that for patients with platelet count below 50 × 10/L, prednisone or intravenous immunoglobulins (IVIg) can be given to raise the platelet count in third trimester in preparation for labor.
To evaluate the effect of low-dose prednisone or IVIg therapy on delivery outcomes in patients with ITP.
This was a cohort study that included pregnant women with ITP from January 2017 to December 2022. Patients with platelet counts of (20-50) ×10/L at the time of delivery (≥34 weeks) and who had not received any medication before were enrolled in the study. Patients were divided into the pre-delivery medication group (oral prednisone or IVIg) and untreated group according to their preferences. The differences in vaginal delivery rate, postpartum bleeding rate, and platelet transfusion volume between the two groups were compared using t-test, Wilcoxon rank-sum test, and χ2 test. Logistic regression analysis was used to identify the factors affecting vaginal delivery rate and postpartum bleeding rate, and multiple linear regression analysis was used to identify the factors affecting platelet transfusion volume.
During the study period, a total of 96 patients with ITP were enrolled, including 70 in the pre-delivery medication group and 26 in the untreated group. The platelet count of pre-delivery medication group was 54.8 ± 34.5 × 10/L, which was significantly higher than that of untreated group 34.4 ± 9.0 × 10/L ( = .004). The vaginal delivery rate of the medication group was higher than the untreated group [60.0% (42/70) vs. 30.8% (8/26), χ2 = 6.49, = .013]. After adjusting for the proportion of multiparous women and gestational weeks, the results showed that medication therapy during the peripartum period was associated with vaginal delivery (OR = 4.937, 95% CI: 1.511-16.136, = .008). The postpartum bleeding rates were 22.9% (16/70) and 26.9% (7/26) in the medication group and untreated group, respectively, with no significant difference between the two groups (χ2 = 0.17, = .789), while the platelet transfusion volume was lower in the medication group than untreated group [(1.1 ± 1.0) vs. (1.6 ± 0.8) U].
Pre-delivery medication therapy can increase vaginal delivery rate, reduce platelet transfusion volume, but does not decrease the incidence of postpartum hemorrhage.
临床研究数据显示，原发性免疫性血小板减少症（ITP）患者在分娩期间会出现一系列不良事件，包括剖宫产率较高。共识报告提出，对于血小板计数低于 50×10/L 的患者，可以在妊娠晚期给予泼尼松或静脉注射免疫球蛋白（IVIg）以提高血小板计数，为分娩做准备。
评估低剂量泼尼松或 IVIg 治疗对 ITP 患者分娩结局的影响。
这是一项队列研究，纳入了 2017 年 1 月至 2022 年 12 月期间的妊娠 ITP 患者。分娩时（≥34 周）血小板计数为（20-50）×10/L，且未接受任何药物治疗的患者纳入研究。根据患者的意愿，将患者分为产前用药组（口服泼尼松或 IVIg）和未治疗组。采用 t 检验、Wilcoxon 秩和检验和 χ2 检验比较两组阴道分娩率、产后出血率和血小板输注量的差异。采用 logistic 回归分析识别影响阴道分娩率和产后出血率的因素，采用多元线性回归分析识别影响血小板输注量的因素。
研究期间共纳入 96 例 ITP 患者，其中产前用药组 70 例，未治疗组 26 例。产前用药组血小板计数为 54.8±34.5×10/L，明显高于未治疗组 34.4±9.0×10/L（ = .004）。用药组阴道分娩率高于未治疗组[60.0%（42/70）比 30.8%（8/26），χ2 = 6.49， = .013]。在校正多产妇比例和孕周后，结果显示围产期用药治疗与阴道分娩相关（OR = 4.937，95%CI：1.511-16.136， = .008）。用药组和未治疗组的产后出血率分别为 22.9%（16/70）和 26.9%（7/26），两组间无显著差异（χ2 = 0.17， = .789），而用药组的血小板输注量低于未治疗组[（1.1±1.0）比（1.6±0.8）U]。
产前用药治疗可提高阴道分娩率，减少血小板输注量，但不降低产后出血发生率。
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