PMM.03 The management of patients with primary immune thrombocytopenia during pregnancy in Leeds

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Abstract

Introduction and objectives

Primary immune thrombocytopenia (ITP) is a rare autoimmune condition that affects women of child bearing age and accounts for around 3% of thrombocytopenias at delivery.1 It can lead to significant maternal and neonatal bleeding complications during labour and postpartum.

Introduction and objectives

The aim of this audit was to evaluate the management of ITP during pregnancy within the Leeds Teaching Hospitals NHS Trust and compare this practice with guidelines set out by the British Committee for Standards in Haematology.

Methods

The patient pathway manager database was used to source a list of women with a diagnosis of ITP. Women were selected using specific inclusion criteria. Retrospective data was then collected from the medical records using a proforma.

Results

A total of 19 pregnancies were audited. Of these, 32% were delivered by lower segment caesarean section, 63% by normal vaginal delivery and 5% by instrumental delivery. A foetal scalp electrode was used in one case, two women required a platelet transfusion during delivery and there were two cases of severe postpartum haemorrhage. Of the neonates, 26% did not have a cord blood platelet count taken at birth, 58% were given IM vitamin K and 10% were admitted to special care baby unit with one requiring a platelet transfusion.

Conclusions

A significant number of the intrapartum precautions documented in the patients’ notes were not followed. Clearer documentation is needed to improve adherence to guidelines as well as the development of trust guidelines to standardise the quality of care provided.

Reference

Myers B. Diagnosis and management of maternal thrombocytopenia in pregnancy. British Journal of Haematology 2012;158:3–15

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