Simon L, Santi T M, Sacquin P, Hamza J
Département d'Anesthésie-Réanimation, Hôpital St Vincent de Paul, Paris, France.
Br J Anaesth. 1997 Jun;78(6):678-83. doi: 10.1093/bja/78.6.678.
The usefulness and optimal timing of laboratory coagulation tests before obstetric extradural analgesia are controversial. Moreover, the significance of mild coagulation abnormalities during pregnancy remains unclear. We have assessed the reliability of coagulation tests performed several weeks before delivery as predictors of coagulation abnormalities during labour. Platelet count, plasma fibrinogen concentration, prothrombin time (PT) and activated partial thromboplastin time (aPTT) were sampled in 797 women during the ninth month of pregnancy and checked during labour. Platelet count was less than 100 x 10(9) litre-1 for 11 women during labour. Only three had been detected by the first sample. Platelet count less than 100 x 10(9) litre-1 or fibrinogen concentration less than 2.9 g litre-1 during labour were associated with an increase in the incidence of postpartum haemorrhage (odds ratio = 19.7). We conclude that a platelet count several weeks before delivery was not reliable in predicting thrombocytopenia during labour and that women with mild coagulation abnormalities in early labour may need special attention regarding the risk of postpartum haemorrhage.
产科硬膜外镇痛前实验室凝血检查的实用性及最佳时机存在争议。此外，孕期轻度凝血异常的意义仍不明确。我们评估了分娩前几周进行的凝血检查作为产时凝血异常预测指标的可靠性。对797名孕妇在妊娠第九个月时进行血小板计数、血浆纤维蛋白原浓度、凝血酶原时间（PT）和活化部分凝血活酶时间（aPTT）检测，并在产时复查。产时有11名妇女血小板计数低于100×10⁹/L。首次采样仅检测出3例。产时血小板计数低于100×10⁹/L或纤维蛋白原浓度低于2.9g/L与产后出血发生率增加相关（比值比=19.7）。我们得出结论，分娩前几周的血小板计数在预测产时血小板减少方面不可靠，产时轻度凝血异常的妇女在产后出血风险方面可能需要特别关注。
