Efficacy of treatment immune thrombocytopenic purpura in pregnancy with corticosteroids and intravenous immunoglobulin: a prospective follow-up of suggested practice
The current study is performed to assess a routine for treatment of immune thrombocytopenic purpura in pregnancy. A prospective programme for monitoring and treatment with intravenous immunoglobulin or cortisone in pregnancies with immune thrombocytopenic purpura was suggested to all delivery units in Sweden. Treatment should be avoided if platelet counts were more than 20 × 109/l during pregnancy with no bleeding complications and with a target of 100 × 109/l at delivery. Descriptive statistics and logistic regression analysis were used. Seventy-five pregnancies were followed; treatment was given in 29 (39%) of the pregnancies; in 13 intravenous immunoglobulin, in six cortisone, in nine a combination of both immunoglobulin and cortisone and in one platelets was given. The mean platelet increase before delivery after immunoglobulin was 46 × 109/l approximately 3 days later. At delivery, 34 (45%) of all pregnancies reached target platelet level more than 100 × 109/l, whereas five (7%) had platelets less than 50 × 109/l. Mode of delivery and blood loss were similar to a reference group. Of the neonates, 23% had platelets less than 50 × 109/l with a nadir reached on day 2–4; 9% required treatment. Women with platelets less than 20 × 109/l in pregnancy or with prior neonatal thrombocytopenia were at a, respectively, five-fold and eight-fold increased risk of neonatal thrombocytopenia. A routine to avoid treatment when platelets are at least 20 × 109/l during pregnancy and to aim for 100 × 109/l at delivery seem safe. Severe maternal thrombocytopenia and prior neonatal thrombocytopenia were predictors of neonatal thrombocytopenia.