International Journal of Reproductive BioMedicine
International Journal of Reproductive BioMedicine
IJRM
Medical Sciences
http://ijrm.ir
1
admin
2476-4108
2476-3772
10.29252/ijrm
en
jalali
1391
7
1
gregorian
2012
10
1
10
5
online
1
fulltext
en
نتایج بارداری در زنان با پورپورای ترومبوسیتوپنی ایدیوپاتیک (ITP)
Pregnancy outcomes in women with idiopathic thrombocytopenic purpura
Original Article
Original Article
<strong><span style="background:white;"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">مقدمه: </span></span></span></strong><span style="background:white;"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">پورپورای ترومبوسیتوپنی ایدیوپاتیک (</span></span></span><span dir="LTR"><span style="font-size:10.0pt;">ITP</span></span><span style="font-family:b mitra;"><span style="font-size:10.0pt;">)</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> به طور شایعی زنان در سنین باروری را مبتلا می­کند و با عوارض مادری و جنینی همراه است.</span></span><br>
<strong><span style="background:white;"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">هدف:</span></span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> هدف از مطالعه حاضر، بررسی نتایج پره ناتال در زنان باردار مبتلا به </span></span><span dir="LTR"><span style="font-size:10.0pt;">ITP</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> می­باشد.</span></span><br>
<strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">مواد و روش­ ها:</span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> این مطالعه بصورت کوهورت آینده­نگر و تحلیلی بر روی بیست و یک زن باردار با </span></span><span dir="LTR"><span style="font-size:10.0pt;">ITP</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;"> در یک بیمارستان آموزشی در تهران از مهر 1387 تا بهمن 1388 انجام و نتایج بارداری آن­ها مطالعه گردید.</span></span><br>
<strong><span style="background:white;"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">نتایج: </span></span></span></strong><span style="background:white;"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">سه بیمار </span></span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">(14/3%) زایمان طبیعی، هفده نفر (81%) زایمان به روش سزارین و یک نفر سقط جنین داشت. 9 مادر (42/9%) پلاکت کمتر از </span></span><span dir="LTR"><span style="font-size:11.0pt;">ml</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">/50000 در هنگام زایمان داشتند ولی تنها در 4 نفر </span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">(19%) خونریزی بعد از زایمان اتفاق افتاد. تزریق پلاکت برای یک نفر در حین زایمان سزارین انجام شد. دیابت بارداری در شش نفر (28/6%) و پره­اکلامسی و دکولمان جفت و مرگ داخل رحمی جنین هر کدام در یک نفر مشاهده گردید. هفده نوزاد (89/5%) پلاکت طبیعی و دو نوزاد (10/5%) ترومبوسیتوپنی متوسط داشتند ولی هیچ نوزادی علائم خونریزی پیدا نکرد. دو نوزاد (510%) دچار کاهش رشد داخل رحمی شده بودند.</span></span><br>
<strong><span style="background:white;"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">نتیجه­ گیری: </span></span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">میزان دیابت بارداری در زنان باردار مبتلا به </span></span><span dir="LTR"><span style="font-size:10.0pt;">ITP</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> نسبت به جمعیت عمومی بیشتر است. خونریزی بعد از زایمان در این زنان شایع است ترومبوسیتوپنی شدید و خونریزی در نوزادان شایع نیست.</span></span>
<strong>Background:</strong> Idiopathic thrombocytopenic purpura (ITP) is a disease that commonly affects women of reproductive age and is associated with maternal and fetal complications.<br>
<strong>Objective: </strong>The aim of the present study was to report the perinatal outcome in pregnant women with ITP. Materials and Methods: Twenty one pregnant women with ITP admitted in a teaching hospital in Tehran, from October 2008 to February 2010, were enrolled in this prospective historical cohort study; course and perinatal outcome of pregnancies were studied.<br>
<strong>Results:</strong> Seven (33.3%) cases had been diagnosed before pregnancy, while the other fourteen (66.7%) were diagnosed during pregnancy. During hospitalization, thirteen (62%) patients required treatment, eight (61.5%) of them with steroids, two (15.3%) received intravenous immunoglobulin (IVIG), and three (23%) were treated with steroids and IVIG. Three babies were delivered vaginally (14.3%), seventeen (81%) through cesarean section and one patient aborted her fetus. Nine mothers (42.9%) had platelet counts <50000/ml at the time of delivery; but postpartum hemorrhage occurred in 4 (19%) women and one women received platelet transfusion during cesarean section. Six (28.6%) women developed gestational diabetes. Pregnancy was complicated by preeclampsia in one woman and by abruptio placenta in another. One pregnancy terminated in intrauterine fetal death. Seventeen infants (89.5%) had normal platelet counts, and two (10.5%) had moderate thrombocytopenia. No infant showed signs of hemorrhage, but 2 neonates (10.5%) were diagnosed with intrauterine growth restriction.<br>
<strong>Conclusion:</strong> Rate of gestational diabetes in pregnant women with ITP is higher than the general population. Rate of gestinational diabetes is 3-5% and postpartum hemorrhage is 5-7% in general. Postpartum hemorrhage is common in these women. Severe thrombocytopenia and bleeding in the newborns are uncommon.
نتایج بارداری,ITP, نتایج نوزادی
Pregnancy outcomes, Idiopathic thrombocytopenic purpura, Neonatal outcome
489
492
http://ijrm.ir/browse.php?a_code=A-10-31-89&slc_lang=en&sid=1
Fakhrolmolouk
Yassaee
فخرالملوک
یاسایی
dr_fyass@yahoo.com