妊娠合并凝血因子缺乏25例临床分析  

Clinical Analysis of 25 Pregnant Women with Coagulation Factor Deficiency

作　　者：徐霞[1] 周瑜[1] 张延珍[1] XU Xia;ZHOU Yu;ZHANG Yanzhen(Department of Obstetrics and Gynecology, Fujian Medical University Union Hospital, Fuzhou 350001, China)

机构地区：[1]福建医科大学附属协和医院妇产科,福州350001

出　　处：《福建医科大学学报》2019年第1期52-56,共5页Journal of Fujian Medical University

摘　　要：目的探讨妊娠合并凝血因子缺乏患者的临床处理和母儿结局。方法收集25例妊娠合并凝血因子缺乏患者(共29次妊娠)的临床资料,回顾性分析其临床处理过程和妊娠结局。结果 (1)一般情况:内源性、外源性及共同途径凝血因子缺乏分别为7,8,14例次;(2)临床处理:3例内源性凝血因子缺乏患者孕期输注血制品,1例Ⅸ因子缺乏患者接受维生素K1肌内注射3 d,余患者孕期未行相关治疗,未发生母儿出血事件;28例次患者术前或进入产程后均输注相应血制品,4例次产后继续输注血制品;(3)分娩结局:29例次均足月活产,分娩孕周为(39±4.2)周。15例次阴道分娩,产后出血量为(280±62)mL,未并发产后出血(>500 mL);14例次剖宫产,产后出血量为(710±94)mL,2例并发产后出血(1 200及1 400 mL),无晚期产后出血;(4)新生儿结局:1例系低纤维蛋白原血症的初产妇,因"羊水过少"要求剖宫产,新生儿Apgar初评4分,5及10 min再评均为10分,余新生儿Apgar初评均10分;9例次新生儿因凝血四项异常转新生儿科,均无颅内出血,治疗后均好转出院。结论妊娠合并凝血因子缺乏患者孕期出血少见,临产后予成分输血纠正凝血功能,剖宫产者出血量仍增加。新生儿凝血异常风险高,出血并发症低,积极治疗后预后好。Objective To summarize the perinatal management and pregnancy outcomes of pregnant women with coagulation factor deficiency. Methods This was a retrospective observational study. The study participants were recruited from January 1, 2014 to January 1, 2018. In this study, 25 cases(29 pregnancies) of pregnancy women with coagulation factor deficiency were collected. Results (1)There were a total of 25 cases with complication of variety of coagulation factors deficiency, including 7 of endogenous coagulation factors deficiency, 8 of extrinsic coagulation factors deficiency, and 14 of common coagulation pathway factors deficiency.(2)Three of them were transfused with blood products during the stage of antepartum.(3)Fifteen of them delivered the baby by vagina smoothly. The other fourteen delivered the baby by C-section and two of them complicated with serious postpartum hemorrhage.(4)There was no late postpartum hemorrhage. Four of them were transfused with blood after postpartum.(5)Only one newborn scored 4 at one minutes and scored 10 five minutes after resuscitation. Nine newborns were diagnosed with abnormal blood coagulation after birth and they were transferred to the pediatrics department. All of them were discharged smoothly. Conclusions It is rare that mother and child happen to hemorrhage during antepartum period. Blood transfusion is necessary when entering the delivery and with the components transfusion to correct the coagulation function, and the amount of bleeding in the cesarean section is still increased. Vaginal delivery is a better choice than cesarean section. Newborns have a high risk of abnormal coagulation and a good prognosis after treatment.

关 键 词：妊娠 血液凝固 血液凝固因子 预后 

分 类 号：R714.3[医药卫生—妇产科学] R714.46[医药卫生—临床医学]