[Analysis of risk factors for preeclampsia in pregnancies complicated with chronic aplastic anemia].
ABSTRACT To investigate the risk factors for preeclampsia(PE) in pregnancies complicated with chronic aplastic anemia (CAA) by analyzing the obstetric management and pregnancy outcome.
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.
(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).
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.