患有出血障碍的患者的怀孕管理
Nidhi Patel1, Bethany Samuelson Bannow2
1Department of Internal Medicine, Providence Portland, Portland, OR.
Hematology. American Society of Hematology. Education Program
|December 5, 2025
概括
患有出血障碍的孕妇面临更高的产后出血风险. 多学科护理和及时的因素水平监测对于在怀孕期间和怀孕后管理出血至关重要.
科学领域:
- 产科和妇科 产科和妇科
- 血液学 血液学 血液学
- 孕产妇和胎儿医学 孕产妇和胎儿医学
背景情况:
- 患有出血障碍 (pwBD) 的孕妇患产后出血 (PPH) 的风险增加.
- 怀孕诱导的高凝血状态可能无法确保pwBD的足够的血液静止,其中包括·维勒布兰德病,定性血小板缺陷 (QPD) 或血友病携带者 (HC).
- 涉及血液学家,产科医生,麻醉科医生和遗传学家的多学科护理对pwBD有益.
研究的目的:
- 概述出血乱的孕妇的风险和管理策略.
- 强调多学科护理和因素水平监测的重要性.
- 讨论pwBD的静血疗法和输送考虑.
主要方法:
- 审查当前的文献和临床实践,以管理怀孕期间的出血障碍.
- 强调获得交付规划的基线和产前因素水平.
- 讨论各种血液静止疗法,包括抗纤维素催化剂,德斯莫普林素,因子缩剂和血液制品.
主要成果:
- 由于无法预测的表型水平相关性,交付的目标因子水平仍然存在争议.
- 抗纤维解质剂,如胺酸,显示了强有力的证据,对PPH管理.
- 人们越来越多地使用因子缩剂,用血液制品作为QPD的替代品,或者当缩剂无法使用时.
结论:
- 交付方式应优先考虑母亲的指示,考虑到对母亲和新生儿的风险,特别是对于HCs.
- 产后治疗可能需要持续数周,因为延迟PPH的高风险.
- 积极的,多学科的管理对于优化pwBD的结果至关重要.
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