摘要
目的 探讨妊娠合并白血病患者的母儿结局. 方法 选择1980年6月1日至201 1年7月31日北京大学人民医院产科收治的进入围产期的23例妊娠合并白血病患者,包括妊娠前诊断的白血病9例（4例急性髓细胞白血病,5例慢性髓细胞白血病）和妊娠期首次诊断的白血病患者14例,其中急性白血病8例（急性髓细胞白血病7例,急性淋巴细胞白血病1例）,慢性髓细胞白血病（慢性期）6例纳入研究,采用回顾性方法对其妊娠期临床处理、妊娠结局进行分析,并对母儿情况进行随访. 结果 （1）妊娠期临床处理：妊娠前诊断的4例急性髓细胞白血病患者中2例妊娠前已停化疗药物≥5年,另2例病情完全缓解,妊娠期病情均无复发,无特殊处理;5例妊娠前诊断的慢性髓细胞白血病患者血常规监测异常,但妊娠期疾病仍一直处于慢性期,妊娠期1例使用羟基脲治疗,1例使用伊马替尼,余3例无任何治疗.14例妊娠期首次诊断的白血病患者中,血常规检查均有白细胞异常,其中9例同时伴有贫血和血小板计数异常,4例伴单一贫血或血小板计数异常.8例急性白血病患者中除1例因妊娠40周和1例发生死胎未进行化疗外,6例进行了化疗.6例慢性髓细胞白血病患者中2例使用羟基脲治疗,1例短期服用伊马替尼,1例行白细胞单采术治疗,1例行血小板单采术治疗,另1例临产入院未治疗.（2）妊娠结局：妊娠期死亡1例,余22例分娩.平均终止妊娠孕周（38.3±2.3）周,21例活产新生儿平均出生体重为（2 755±486）g.妊娠期并发子痫前期5例,弥漫性血管内凝血2例,胎盘早剥1例.产后出血5例,平均出血（1 200±751） ml,产褥感染2例,孕产妇死亡1例.围产儿23例,其中早产儿4例,低出生体重儿4例,死胎2例,伴出生缺陷1例,伴血常规异常2例.8例剖宫产分娩,2例产钳助产分娩,12例阴道分娩.（3）随访情况：妊娠期死亡1例,其余22例失访4例,余1 8例随访
Objective To investigate the perinatal outcomes and management of pregnancy with leukemia. Methods From June 1, 1980 to July 31, 2011, 23 pregnant women with leukemia, were admitted to the Department of Obstetrics of Peking University People＇s Hospital. Clinical data of these women were collected and analyzed retrospectively. Among the 23 cases, nine were diagnosed before pregnancy including four with acute myeloid leukemia （ AML ） and five with chronic myeloid leukemia （ CML ） , and 14 diagnosed during pregnancy including eight with acute leukemia （ AL ） [seven with AML and one with acute lymphocytic leukemia （ ALL ）] and six with CML. The prognosis of the mothers and infants were followed up. Results （ 1 ） Managements during pregnancy： For the four cases with AML, two were completely recovered and the other two had completed chemotherapy five years before pregnancy, and no relapse was reported during pregnancy. The other five cases with CML were stable during pregnancy although the results of blood routine tests were abnormal. Among them, one case was treated with hydroxyurea and one with imatinib during pregnancy, while the other three women received no treatment. For those 14 cases diagnosed during pregnancy, all were recorded with abnormal white blood counts, and nine complicated with anemia and abnormal platelet count and four with either anemia or abnormal platelet count. Among the eight cases with AL, six received chemotherapy during pregnancy and two did not due to intrauterine fetal death and 40 weeks of gestation on admission, respectively.For the six CML women, two received hydroxyurea, one took imatinib, one took leukapheresis and one accepted plateletpheresis during pregnancy, but one woman received no treatment due to regular contractions on admission. （2） Perinatal outcomes： The average gestational weeks on delivery was （38.3±2.3） weeks, and the average birth weight of newborns was （ 2 755 ±486 ） g. There were two cases of disseminated intravascular coagula
出处
《中华围产医学杂志》
CAS
北大核心
2014年第2期93-98,共6页
Chinese Journal of Perinatal Medicine
关键词
妊娠并发症
肿瘤
白血病
妊娠结局
Pregnancy complications, neoplastic
Leukemia
Pregnancy outcome
