Sharma S K, Philip J, Whitten C W, Padakandla U B, Landers D F
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas 75235-9068, USA.
Anesthesiology. 1999 Feb;90(2):385-90. doi: 10.1097/00000542-199902000-00009.
Preeclampsia is associated with a risk of abnormal hemostasis that occurs most commonly secondary to thrombocytopenia. Thromboelastography measures whole blood coagulation and has been used to manage coagulation defects in obstetric patients. The authors conducted this investigation in a large number of preeclamptic women to assess changes in coagulation using thromboelastography.
Thromboelastography and platelet counts were performed in 52 healthy pregnant women, 140 mild preeclamptic women, and 114 severe preeclamptic women in active labor using disposable plastic cups and pins and native whole blood. In preeclamptic patients with a platelet count <100,000/mm3, conventional coagulation tests were also performed. Epidural analgesia was provided in some women when they requested pain relief.
Fifteen percent of all preeclamptic women (38 of 254) and 2% (1 of 52) of healthy pregnant women had a platelet count <100,000/mm3. The incidence of thrombocytopenia <100,000/mm3 was 3% (4 of 140) and 30% (34 of 114) in mild preeclamptic patients and severe preeclamptic patients, respectively. Severe preeclamptic patients with a platelet count <100,000/mm3 were significantly hypocoagulable when compared to the other study groups. Ten severe preeclamptic women with a platelet count <100,000/mm3 had a maximum amplitude <54 mm (the lower limit of maximum amplitude in healthy pregnant women enrolled in this investigation). None of the mild preeclamptic women had a maximum amplitude <54 mm. Five severe preeclamptic women with a platelet count <100,000/mm3 had an abnormal coagulation profile, whereas all four mild preeclamptic women with a platelet count <100,000/mm3 had a normal coagulation profile.
This study shows that severe preeclamptic women with a platelet count <100,000/mm3 are hypocoagulable when compared to healthy pregnant women and other preeclamptic women.
子痫前期与异常止血风险相关，最常见的是继发于血小板减少症。血栓弹力图可测量全血凝血功能，并已用于管理产科患者的凝血缺陷。作者对大量子痫前期女性进行了此项研究，以使用血栓弹力图评估凝血变化。
使用一次性塑料杯、采血针和全血，对52名健康孕妇、140名单纯性子痫前期女性和114名重度子痫前期且处于活跃期分娩的女性进行血栓弹力图和血小板计数检测。对于血小板计数<100,000/mm³的子痫前期患者，还进行了传统凝血试验。部分女性要求缓解疼痛时给予硬膜外镇痛。
所有子痫前期女性中有15%（254例中的38例）血小板计数<100,000/mm³，健康孕妇中有2%（52例中的1例）血小板计数<100,000/mm³。单纯性子痫前期患者和重度子痫前期患者中血小板计数<100,000/mm³的发生率分别为3%（140例中的4例）和30%（114例中的34例）。与其他研究组相比，血小板计数<100,000/mm³的重度子痫前期患者凝血功能明显低下。10名血小板计数<100,000/mm³的重度子痫前期女性最大振幅<54 mm（本研究纳入的健康孕妇最大振幅下限）。单纯性子痫前期女性均无最大振幅<54 mm。5名血小板计数<100,000/mm³的重度子痫前期女性凝血图谱异常，而4名血小板计数<100,000/mm³的单纯性子痫前期女性凝血图谱均正常。
本研究表明，与健康孕妇和其他子痫前期女性相比，血小板计数<100,000/mm³的重度子痫前期女性凝血功能低下。
