[Analysis of risk factors for adverse perinatal outcomes in women with pancytopenia].

ABSTRACT

OBJECTIVE: To explore the pregnancy outcomes of women with pancytopenia and the risk factors for the adverse perinatal outcomes. METHODS: A total of 106 pregnant women with pancytopenia were admitted to Peking University People's Hospital from Jan. 2005 to Sep. 2014. The clinical data and the pregnancy outcomes were reviewed retrospectively to investigate the risk factors for the adverse perinatal outcomes. RESULTS: (1 ) Eighty-four patients were found pancytopenia before pregnancy while 22 were found for the first time during pregnancy. Sixty-four patients were diagnosed as aplastic anemia; 30 as myelodysplastic syndrome; 2 as paroxysmal nocturnal hemoglobinuria; 4 as hypersplenism, and 1 as anti-phospholipid syndrome. Diagnoses of the remaining 5 patients were uncertain. (2) Sixty-nine patients received at least one time blood transfusion before delivery. (3) As for the complications, nine women developed gestational diabetes; twenty-two suffered severe preeclampsia (SPE); two were diagnosed as anemic heart disease and three experienced respiratory tract infection. The postpartum blood loss ranged from 50 ml to 3 800 ml, with the median of 400 ml. And six women had the blood loss more than 1 000 ml. The gestational age at delivery ranged from 24 weeks to 40 weeks, with the median of 37.0 weeks. (4) Thirty-one patients suffered adverse perinatal outcomes, including 3 cases of intrauterine death, 4 therapeutic labor induction before 28 gestational weeks, 6 premature delivery before 34 weeks. There were 2 neonates complicated with intracranial hemorrhage, 2 with neonatal respiratory distress syndrome, 3 with hypoxic-ischemic encephalopathy, 2 with severe asphyxia and death, and 14 with small for gestational age. Among the patients with adverse perinatal outcomes, 26 women received blood transfusion during pregnancy and 17 developed SPE. The maximum and the minimum value of their white cell count (WBC), hemoglobin concentration (Hb) and blood platelet count (BPC) were (4.9±1.4)×10(9)/L, (2.9±0.8)×10(9)/L, (88.6±14.9) g/L, (57.9±14.5) g/L, (47.7±27.4)×10(9)/L and (11.9±12.3)×10(9)/L, respectively. For those patients without adverse perinatal outcomes, 43 received blood transfusion during pregnancy and 5 developed SPE. The maximum and the minimum value of their WBC, Hb and BPC were (5.2±1.5)×10(9)/L, (3.2±0.9)×10(9)/L, (101.4±16.2) g/L, (71.9 ± 14.5) g/L, (52.3 ± 24.0) × 10(9)/L and (19.0±12.1) × 10(9)/L, respectively. The multivariate regression analyses indicated that SPE, Hb less than 70 g/L and BPC less than 20×10(9)/L were the independent risk factors for the poor perinatal outcomes in pregnant women with pancytopenia (P<0.05). CONCLUSIONS: The incidence of adverse perinatal complications increased dramatically in pregnant women with pancytopenia. Concurrent SPE, minimum Hb less than 70 g/L and minimum BPC less than 20 × 10(9)/L may be the independent risk factors for the adverse perinatal outcomes.