Roberts W E, Perry K G, Woods J B, Files J C, Blake P G, Martin J N
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505.
Am J Obstet Gynecol. 1994 Sep;171(3):799-804. doi: 10.1016/0002-9378(94)90101-5.
We wished to determine in patients with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) whether (1) there is an intrapartum threshold platelet count that is predictive of immediate or delayed hemorrhagic complications and (2) whether prophylactic platelet transfusion at delivery prevents these outcomes.
In this retrospective, descriptive study, the peripartal courses of 132 patients with class 1 (< or = 50,000/microliters platelet nadir) and 160 patients with class 2 (> 50,000 but < or = 100,000/microliters platelet nadir) HELLP syndrome were reviewed with special attention to laboratory data, evidence of hemorrhage, and details of platelet transfusion therapy.
A higher incidence of postpartum hemorrhagic complications (p < 0.001) occurred in class 1 versus class 2 HELLP pregnancies. The tendency to have postpartum incisional bleeding after abdominal or vaginal delivery was related to the degree of thrombocytopenia (p = 0.006). The antepartum threshold platelet count most predictive of subsequent postpartum hemorrhagic complications was < or = 40,000/microliters. The prophylactic administration of platelets does not appear to have either significantly decreased the incidence of postpartum hemorrhagic complications or significantly hastened normalization of the postpartum platelet count.
Although bleeding in the gravid patient is related to more factors than platelet count alone, patients with HELLP syndrome in whom an intrapartum platelet count above 40,000/microliters maintained are unlikely to have clinically significant postpartum bleeding. Patients with intrapartum platelet counts < or = 40,000/microliters, however, are at significant risk for postpartum bleeding, but prophylactic platelet transfusion at delivery does not ensure a significantly lower incidence of postpartum hemorrhagic complications.
我们希望确定在患有HELLP综合征（溶血、肝酶升高和血小板减少）的患者中，（1）是否存在可预测即刻或延迟出血并发症的产时血小板计数阈值，以及（2）分娩时预防性输注血小板是否能预防这些结局。
在这项回顾性描述性研究中，对132例1级（血小板最低点≤50,000/微升）和160例2级（血小板最低点＞50,000但≤100,000/微升）HELLP综合征患者的围产期病程进行了回顾，特别关注实验室数据、出血证据和血小板输注治疗细节。
1级HELLP妊娠产后出血并发症的发生率高于2级（p＜0.001）。腹部或阴道分娩后发生产后切口出血的倾向与血小板减少程度有关（p = 0.006）。最能预测随后产后出血并发症的产前血小板计数阈值为≤40,000/微升。预防性输注血小板似乎既未显著降低产后出血并发症的发生率，也未显著加速产后血小板计数恢复正常。
虽然妊娠患者出血涉及的因素不止血小板计数，但产时血小板计数维持在40,000/微升以上的HELLP综合征患者产后发生具有临床意义出血的可能性不大。然而，产时血小板计数≤40,000/微升的患者产后出血风险很大，但分娩时预防性输注血小板并不能确保显著降低产后出血并发症的发生率。
