[Analysis of risk factors for preeclampsia in pregnancies complicated with chronic aplastic anemia].

OBJECTIVE: To investigate the risk factors for preeclampsia(PE) in pregnancies complicated with chronic aplastic anemia (CAA) by analyzing the obstetric management and pregnancy outcome. METHODS: Retrospectively review the clinical data including the obstetric management, the laboratory findings and the pregnancy outcome of 41 pregnant women complicated with CAA, all of whom were hospitalized in Peking University People's Hospital from May 2002 to February 2011. Multiple logistic regression was used to explore the risk factors associated with PE. RESULTS: (1) Twenty-eight patients were diagnosed before conception while 13 were diagnosed during gestation. Eleven patients including all the 7 who were categorized as severe CAA presented with mild bleeding in the third trimester. (2) The medians of white blood cell counts, hemoglobin concentrations and platelet counts were 5.0×109/L, 66.0 g/L and 12.0×109/L respectively. (3) The obstetric management consisted of strict assessment, intensive surveillance and follow-up, appropriate supportive measures, timely recognition of complications, and delivery when necessary. Twenty-one patients received supportive transfusions. Ten patients developed PE, all of whom were diagnosed as severe PE (SPE). Twelve patients suffered postpartum hemorrhage, and 3 of them had blood loss more than 1000 ml. All were conservatively treated in success. (4) The median gestational age of delivery was 37 weeks. Sixteen cases delivered before 37 weeks and 5 delivered before 34 weeks. Two patients developed SPE at 29 weeks and 30 weeks respectively, and both of the neonates died for severe asphyxia. The birth weight of the live neonates ranged from 1500 to 3660 g. (5) The postpartum follow-up period ranged from 6 months to 7 years. Thirty-three patients got improvement without dependence on transfusions. Four achieved no remission and still needed intermittent transfusions. Four were lost in follow-up. (6) Significant differences were found in the bleeding tendency, the platelet counts and the delivery weeks when comparing the patients developing PE and those without PE. No differences were found with regard to the age, the gestational age of first visit, the percentage of patients diagnosed before conception, the percentage of severe CAA, the choice of treatment, the white blood cell counts and the hemoglobin level. The Multiple logistic regression showed that the platelet count less than 10×109/L was an independent risk factor for CAA patients developing PE (P = 0.006). CONCLUSIONS: Most pregnancies complicated with CAA could achieve good maternal and fetal outcome, when intensive prenatal care and supportive management are provided. SPE is the most common complication. The platelet count less than 10×109/L is perhaps an independent risk factor for CAA patients developing PE.

[Analysis of the perinatal outcome and risk factors for pregnancies complicated with chronic renal diseases].

OBJECTIVE: To investigate the perinatal outcome for pregnancies complicated with chronic renal diseases, and the risk factors for the adverse outcome. METHODS: Retrospectively analyze the clinical data of 48 patients with chronic renal diseases complicating pregnancy admitted in Peking University People's Hospital between January 1998 and August 2010, record the pregnancy outcome and explore the risk factors for the poor outcome using multivariate regression analysis. RESULTS: Thirty-eight patients had known chronic renal disease before conception, and ten were diagnosed during pregnancy. Seven patients (15%, 7/48) presented with obvious renal impairment [serum creatinine (sCr) ≥ 125 µmol/L] prepregnancy, and nine (19%, 9/48) were recorded with chronic hypertension. Thirty-three patients received regular prenatal care. Twenty-one cases (44%, 21/48) developed preeclampsia. During the gestation, normal renal function (defined as sCr < 71 µmol/L) was seen in nineteen cases (40%, 19/48), mild dysfunction (sCr ranged 71 - 132 µmol/L) in twenty (42%, 20/48) and moderate to severe dysfunction (sCr ≥ 132 µmol/L) in nine cases (19%, 9/48). Twenty patients had negative or mild proteinuria (24 hour urine protein < 2000 mg), 19 had moderate (24 hour urine protein ranged 2000 - 5000 mg) and nine had severe proteinuria (24 hour urine protein ≥ 5000 mg). The gestational age at delivery ranged from 24 to 41 weeks and the neonatal birth weight ranged from 890 to 4150 g. A total of twenty patients (42%, 20/48) suffered adverse perinatal outcome, including one case with late spontaneous abortion, fifteen with preterm delivery, eleven with small for gestational age, two with neonatal respiratory distress syndrome and four with perinatal death. Declined maternal renal function was seen in eight patients, and two patients progressed toward the end-stage renal failure (the stage of uremia). Multivariate regression analysis identified that preeclampsia (OR = 24.72, P = 0.002) and the degree of proteinuria (OR = 4.24, P = 0.032) were the independent risk factors for the adverse perinatal outcome. CONCLUSIONS: Pregnancies complicated with chronic renal diseases have significantly high incidence of preeclampsia and adverse perinatal outcome. Preeclampsia and the degree of proteinuria are perhaps the independent risk factors for the adverse outcome.

[Clinical analysis about the management and the perinatal outcomes of pregnancy with chronic myeloid leukemia].

OBJECTIVE: to investigate the perinatal outcomes of pregnancy with chronic myeloid leukemia (CML) and how to manage it during pregnancy. METHODS: to retrospectively analyse the clinical datas about the perinatal outcome and the obstetric management of the 16 cases of pregnancy with CML during the last 30 years in a single center. RESULTS: (1) management ang perinatal outcomes: among the 16 pregnancies nine ended with therapeutic abortion during the first or second trimester and no CML complications were observed. The average gestation week was 7 weeks (5 - 13 weeks) when they came to our hospital. Seven pregnancies gave birth, among which CML was diagnosed during pregnancy in four patients and pregnancy was confirmed during CML in three patients. The average gestation week was 36 weeks (27 - 40 weeks(+2)) when they came to our hospital. Among the seven women three were treated with hydroxyurea (one became pregnant while she was on hydroxyurea and she elected to continue her pregnancy and continued to use hydroxyurea), one with leukapheresis twice after her 40 weeks of gestation, one with plateletpheresis and three hadn't any treatment. In the seven pregnacies three developed severe pre-eclampsias, including the two had hydroxyurea during the gestation. The average delivery gestational week was 38 weeks (33 weeks(+4) - 41 weeks), two were premature birth. Two caesarean sections, three vaginal deliveries and two forceps deliveries. There were two postpartum hemorrhage, during the 24 hours the amount of bleeding was 1500 - 1800 ml and secondary disseminated intravascular coagulation happened. Seven patients gave birth to seven infants whose average birth weight was 2469 g (1820 - 2810 g), of whom two were premature infants, two low birth weight infants, one had congenital malformation and two had abnormal blood routine examinations. (2) Management after delivery and prognosis: during the nine patients who ended pregnancy with therapeutic abortion during the first or second trimester four withdraw, one died whose course of disease was 3 years and the other four were alive during 5 months to 72 months, among which one had stem cell transplantation, two are taking imatinib mesylate and one takes hydroxyurea. Among the seven patients who deliveried two withdraw, two died and three are alive. Among the seven infants two withdraw, the other five have normal development following 4 months to 9 years. CONCLUSIONS: CML patient may have successful pregnancy and delivery, and it is not the absolute indication for terminating pregnancy. On the other hand, CML and the treatment during pregnancy can have side effect on the mother and the fetus, so the patients should be monitored and treated in tertiary hospitals.

[Clinical analysis of pregnancy complicated with severe thrombocytopenia].

OBJECTIVE: To investigate the etiology and perinatal outcome of pregnancies complicated with extremely severe thrombocytopenia [at least two times of platelets count (PLT) < 10 × 10(9)/L during pregnancy]. METHODS: Clinical data, including basic information, etiology, management and outcomes of pregnant women with extremely severe thrombocytopenia, admitted to Peking University People's Hospital from January 2004 to March 2009, were retrospectively collected. The management of these cases varied according to different etiology and the symptoms: (1) PLT were maintained > 20 × 10(9)/L and hemoglobulin > 70 g/L in those women without spontaneous bleeding; (2) PLT transfusion would be required when PLT < 10 × 10(9)/L or bleeding occur and RBC would be supplied when hematocrit < 25% and hemoglobulin < 70 g/L; (3) Hemoglobulin should be > 70 g/L and PLT > 30 × 10(9)/L before cesarean section or delivery; (4) Predinisone and/or intravenous immunoglobulin G (IVIG) would be given in women complicated with idiopathic thrombocytopenic purpura (ITP) when PLT < (20 - 30) × 10(9)/L or bleeding. PLT would be given if all the above management were failed, or PLT < 10 × 10(9)/L, or bleeding. Women without bleeding would be closely monitored and delivery would be planned. RESULTS: (1) Twenty-six cases were identified among 9302 deliveries during the study period (0.28%), with an average of maternal age of 29. Seventeen were diagnosed before conception and 9 during pregnancy. Among the 26 women, half received regular prenatal check in our hospital and the average gestations at diagnosis was 24 weeks and the other half without regular prenatal visits and the average gestations at diagnosis was 32 weeks. Etiology was identified in 24 out of the 26 women, including 14 (54%) ITP, 5 myelodysplastic syndrome (MDS), 4 chronic aplastic anaemia (CAA) and 1 systemic lupus erythematosus (SLE). (2) MANAGEMENT: All of the 26 women received blood products. Among the 14 ITP cases, 6 received predinisone and IVIG and 8 only took predinisone. Nine of the 26 patients (35%) had pregnant complications, among which 6 (6/9) were preeclampsia. The overall average gestation at delivery was 36 weeks. Only 2 delivered vaginally with the average blood loss of 83 ml and 23 cesarean sections were performed with the average blood loss of 410 ml. (3) Perinatal outcomes: There were 26 perinatal babies, among which 1 died intrauterine and 25 were born alive (12 preterm infants). The average birth weight was 2877 g. Neonatal severe thrombocytopenia presented in 2 newborns whose mother complicated with ITP. CONCLUSIONS: The main cause of extremely severe thrombocytopenia during pregnancy is ITP, managed mainly by predinisone and IVIG, followed by CAA and MDS, which may require supportive treatment. Pregnancy complicated with extremely severe thrombocytopenia is not an indication of termination. Better maternal and fetal outcomes can be achieved through proper treatment based on the etiology, intensive care in prevention and management of complications and cesarean section.

[Clinical analysis of bicytopenia and pancytopenia during pregnancy].

OBJECTIVE: To investigate the diagnosis, management, pregnancy outcome and prognosis of bicytopenia or pancytopenia during pregnancy. METHODS: Retrospective chart review was conducted on 24 pregnancies who were found bicytopenia or pancytopenia during pregnancy for the first time. The diagnoses were reconfirmed. The management and pregnancy outcome were collected. And the prognoses were followed. RESULTS: According to the clinical data and laboratory findings, the latter including complete blood cell count, reticulocyte count, peripheral smear, serum folate and vitamin B12 level, autoimmune antibody screening, bone marrow smear and biopsy, thirteen patients were diagnosed as having chronic aplastic anemia (CAA), six as having myelodysplastic syndromes (MDS), two as having megaloblastic anemia (MA), one as having paroxysmal nocturnal hemoglobinuria (PNH), one as having Evan's syndrome and one as having acute leukemia. The management basically consisted of supportive transfusions. Six patients suffered pregnancy complications including four with severe preeclampsia (one with intracranial hemorrhage and one with intrauterine death concomitantly) and two with gestational diabetes. The delivery ages of the 21 patients were term or nearly term with all good neonatal outcomes. Postpartum follow-up showed the two patients with MA achieved complete remission, the one with PNH had mild anemia and that with Evan's syndrome had mild thrombocytopenia. The patient with acute leukemia died of recurrence six months postpartum. Of the thirteen patients with CAA, two achieved complete remission, six partial remission, four no remission and one was lost follow-up. Of the 6 patients with MDS, one achieved partial remission, four no remission, and one transformed into acute monocytic leukemia, then refused chemotherapy and was lost follow-up. CONCLUSIONS: CAA may be one of the most common causes of bicytopenia or pancytopenia during pregnancy, MDS may be the second. Diagnosis should be made as soon as possible through appropriate and reasonable laboratory examinations. Most patients could achieve good pregnancy outcomes through supportive management. The maternal prognosis may vary widely depending on the causes.

[Effect of general anesthesia used in cesarean section on maternal-neonatal outcome of pregnancy complicated with severe thrombocytopenia].

OBJECTIVE: To investigate the effect of general anesthesia on pregnancy women with thrombocytopenia and neonate during cesarean section (CS). METHODS: Sixty-five singleton pregnant women with low platelet count (< 50 x 10(9)/L) and gestation>35 weeks were allocated into general anesthesia group (35 cases) and local anesthesia group (30 cases) randomly. The time from skin incision to fetal delivery, the oxyhemoglobin saturation (SO2) before and after anesthesia, the blood loss during operation, Apgar scores at 1 min, birth weight,umbilical cord blood gas analysis were recorded. RESULTS: The mean time from anesthesia induction to fetal delivery was (9.7 +/- 3.5) minutes in general anesthesia group. The time from skin incision to fetal delivery in general anesthesia group [(7.7 +/- 2.5) minutes] was shorter than that in local anesthesia group [(12.5 +/- 3.0) minutes, P < 0.01], while the operation time had no significant differences. There were no significant difference for the value of SO2 before and after general anesthesia or local anesthesia (P > 0.05). There was no significant difference for the blood loss [(471 +/- 245) ml vs. (452 +/- 213) ml, P > 0.05], Apgar scores at 1 minute, birth weight and umbilical cord blood gas analysis between the two groups (P > 0.05). There had two infants with blue asphyxia in local anesthesia group while no infant with asphyxia in general anesthesia group. CONCLUSION: General anesthesia is safe to pregnant women with thrombocytopenia during CS.

[Clinical evaluation of propess for induction of term pregnancy].

OBJECTIVE: To explore the efficacy and safety of continuously released prostaglandin E(2) (PGE(2)) suppository-propess used for induction of term pregnancy. METHODS: A multicenter, prospective, case control clinical study was carried out, propess was used in 100 cases as study group, the suppository without PGE(2) was used in 49 cases as control group. The cervical maturity (by Bishop scoring), the time to labor starting, membrane rupture and delivery, the application of oxytocin, ceserean section rate, fetal and neonatal condition were compared between 2 groups after inserting of the suppository. At the same time, side effects caused by propess were investigated. RESULTS: Bishop score was increased >or= 2 points in 93% cases, >or= 3 points in 87% cases in study group, whereas only 4% cases whose Bishop score increased >or= 2 points in control group. The time to labor starting, membrane rupture, and delivery was shortened obviously in study group than that in control group after inserting suppository. The application of oxytocin was much less in study group, cesarean section rate was reduced in study group (32% vs 61%). There was no significant difference between 2 groups in fetal and neonatal conditions. The overstimulation of uterine contraction and mild gastrointestinal tract reaction occurred in 3 cases and 2 cases respectively in study groups. CONCLUSION: Propess can be used for induction of term pregnancy effectively and safely.