DOI: 10.1097/01.aoa.0000288297.29318.3b
,
Issn Print: 0275-665X
Publication Date: 2007/09/01
Facebook
Twitter
LinkedIn
Email
 |
Checking for direct PDF access through Ovid | |
Excerpt
Idiopathic thrombocytopenic purpura (ITP) often affects women of childbearing age and is associated with maternal and fetal complications. It occurs in 1 to 2 per 1000 pregnancies. Although ITP does not preclude pregnancy, additional monitoring and therapy are needed. Management of pregnant women with ITP is complex because of disparities between maternal and fetal platelet counts. This retrospective study reports the authors' experience of ITP during pregnancy over a 7-yr period from 1997 to 2003.
Ninety-two women, aged 18 to 40 yr, attended the hematology clinic during the study period, and 19 pregnancies in 16 of these women were complicated with ITP. The diagnosis of ITP was based on standard criteria. Maternal platelet count was determined every 4 wk from diagnosis of pregnancy to delivery. Mild, moderate, and severe thrombocytopenia were defined as platelet counts of 100,000 to 150,000/μL, 50,000 to 99,000/μL, and <50,000/μL, respectively. The women were allowed to continue their pregnancies and to go into spontaneous labor. Intervention was performed for obstetric reasons and the third stage of labor was managed actively with monitoring for postpartum hemorrhage. Newborn platelet counts were performed at birth and on day 4 of life. Neonatal passive immune thrombocytopenia was defined as a platelet count of <150,000/μL.
The median age of the women at delivery was 27 yr; median gestational age was 38 wk. Eight patients were diagnosed with ITP at the time of conception. Five had splenectomy before conception and one of these five required treatment; the other four had normal platelet counts and did not require any treatment during pregnancy. Of the three women without splenectomy, one had diagnosis of ITP 2 mo before conception, and two were diagnosed at 1 yr before conception. The other eight patients were diagnosed during pregnancy, with four diagnosed in the first trimester. Two had severe thrombocytopenia along with hemorrhagic manifestations. They were treated with prednisolone. One of two patients with moderate thrombocytopenia at diagnosis was treated with oral prednisolone; the other was asymptomatic and did not receive any treatment. Two patients were diagnosed in the second trimester, one with moderate thrombocytopenia that required no treatment; the other patient received oral prednisolone. The last two patients were diagnosed in the third trimester; one received oral prednisolone during her first pregnancy but no treatment in the second pregnancy. The other patient received oral prednisolone and IV immunoglobulins. Five patients in six pregnancies received prednisolone in the first trimester, but none of the newborns had congenital malformations. At delivery of the 19 pregnancies, 12 had low platelet counts but none had thrombocytopenia. Four women had cesarean section for obstetric indications (fetal distress and breech presentation). No postpartum hemorrhage or maternal death occurred. Eighteen babies were born from the 19 pregnancies; 13 had normal and 5 had low platelet counts. Of 14 women who had thrombocytopenia at delivery, only 5 babies had thrombocytopenia and 4 were born vaginally. Platelet counts reached normal levels spontaneously on day 4. None of the newborns had hemorrhagic manifestations or required treatment.
Obstetric and neonatal outcome is generally good in women with ITP diagnosed during the index pregnancy or known from previous pregnancies. Perinatal outcomes were generally also good, with no intracranial bleeding regardless of the mode of delivery.
