Reliable predictors of neonatal immune thrombocytopenia in pregnant women with idiopathic thrombocytopenic purpura (original) (raw)
Related papers
Pregnancy of patients with idiopathic thrombocytopenic purpura: maternal and neonatal outcomes
Journal of the Turkish-German Gynecological Association, 2019
Objective: Thrombocytopenia occurs at 7% of pregnant women. Along with other causes, idiopathic thrombocytopenic purpura (ITP) which is an autoimmune disease with autoantibodies causing platelet destruction must be considered in differential diagnosis. Antiplatelet antibodies can cross the plasenta and cause thrombocytopenia at newborn. Aim of our study is to assess management of ITP in pregnancy, and to investigate neonatal outcomes. Material and Methods: This retrospective study was conducted in a tertiary center including 89 pregnant patients with ITP followed between October 2011 and January 2018. Patients were evaluated in two groups due to diagnosis of ITP and chronic ITP. Age, obstetric history, ITP diagnose and follow up period, presence of splenectomy, platelet count during pregnancy and after birth, treatment during pregnancy, route of delivery, weight and platelet count of newborn, sign of hemorrhage, and fetal congenital anomaly were assessed. Results: Considering ITP and chronic ITP groups, no significant difference was seen with respect to parity, timing of delivery, preoperative and postoperative platelet counts and hemoglobin values. Route of delivery, birth weight, APGAR scores, newborn platelet count, and congenital anomaly rates were also similar. Timing of treatment were different as patiens whose diagnosis were established during pregnancy were mostly treated for preparation of delivery. Treatment modalities were similar. Conclusion: Probability of severe thrombocytopenia at delivery is higher in ITP patients who were diagnosed during pregnancy when compared to patients who got prepregnancy diagnosis. ITP is an important disease for both mother and newborn. Patients should be followed closely in cooperation with hematology department.
Annals of Hematology, 2003
We observed 13 pregnant women of 70 females with idiopathic thrombocytopenic purpura (ITP) from January 1992 through September 2002. Thirteen mothers with ITP gave birth to twelve babies and two fetuses died. One of the pregnancies produced twins. Seven of the cases were diagnosed with ITP before pregnancy and six during pregnancy. One of the thirteen pregnancies was complicated by preeclampsia, one by ablatio placentae, and one by intrauterine death. Seven mothers received corticosteroid treatment, four high-dose immunoglobulin therapies, and one underwent splenectomy in the second trimester of gestation. At the time of delivery six mothers had normal platelet counts and seven had low platelet counts. Nine deliveries were by vaginal route and four were by cesarean section. Eleven infants were born with normal platelet counts and one was thrombocytopenic at the time of delivery. No infant showed any clinical signs of hemorrhage and there were no neonatal complications. Two fetuses died; one of them because of ablatio placentae and the other was intrauterine dead. In conclusion, ITP in pregnancy requires the management of two patients, the mother and her baby; hence, the close collaboration of a multidisciplinary group composed of a hematologist, obstetrician, anesthesiologist, and neonatologist is essential.
Maternal and neonatal outcomes in pregnant women with immune thrombocytopenic purpura
Evidence Based Womenʼs Health Journal, 2014
Background: The aim of this study was to evaluate the outcome of pregnancies in Iranian women with immune thrombocytopenic purpura (ITP). Methods: In a historical cohort study, maternal and neonatal outcomes were studied in 30 pregnant women with ITP at a hospital in Tehran, from January 1994 through November 2003. Results: Twenty-two cases were diagnosed as ITP before and 8 during pregnancy. Thrombocytopenia (platelet count <150 × 10 9 /L) occurred in 22 pregnancies. Eleven (37%) had vaginal delivery and 19 (63%) underwent elective cesarean section. Eight women had severe postpartum hemorrhage. All live-born neonates were delivered in good condition at term. Neonatal thrombocytopenia occurred in 20 (67%) neonates. No bleeding complications occurred in any of the neonates. Conclusion: The outcome of pregnancy in pregnant women with ITP is generally good. Cesarean section should only be performed for obstetric indications. Postpartum hemorrhage is common in these women. Postpartum hemorrhage is unrelated to the mode of delivery. Severe thrombocytopenia and bleeding in the offspring are uncommon.
Management of immune thrombocytopenia in pregnancy
Annals of Blood, 2021
Immune thrombocytopenia (ITP) presents unique challenges in the peripartum setting. The diagnosis of ITP is similar to the nonpregnant patient except pregnancy related causes of thrombocytopenia must be considered. Management of ITP will change over the course of pregnancy and closer monitoring is critical as delivery approaches when the recommended platelet goal increases from 20×10 9-30×10 9 /L to above 50×10 9 /L for a vaginal delivery. If an epidural is required, the platelet count should be above 70×10 9 /L. The mode of delivery is based on obstetrical indications. First line therapies are glucocorticoids or intravenous immunoglobulin (IVIG). Many second line therapies may be safe in pregnancy. Contraindicated therapies include syk inhibitors, vinca alkaloids, mycophenolate mofetil, cyclophosphamide and danazol. Limited case series report safe administration of the thrombopoietin receptor agonists (TPORAs) without adverse fetal outcomes. While the majority of neonates are unaffected, neonatal platelet counts can decline in the first days after delivery and may require therapy. Maternal treatment and platelet count do not appear to predict the risk of neonatal thrombocytopenia; the strongest predictor is a previous sibling's history. ITP is not a contraindication for pregnancy; women with a history of ITP should not be discouraged from becoming pregnant as their ITP can be safely managed with close monitoring and multidisciplinary coordination with obstetrics and pediatrics.
Maternal and perinatal outcome in idiopathic thrombocytopenic purpura (ITP) with pregnancy
Acta Obstetricia et Gynecologica Scandinavica, 2006
Background. Idiopathic thrombocytopenic purpura commonly affects women of childbearing age and is associated with maternal and fetal complications. Management of a pregnant patient is difficult and requires combined care of obstetrician and a neonatologist. We report our experience of idiopathic thrombocytopenic purpura during pregnancy during the last 7 years. Method. A retrospective study over the 7-year period 1997 Á2003 was carried out in the Department of Obstetrics and Gynaecology in the Postgraduate Institute of Medical Education and Research, Chandigarh, India. The course of pregnancy, disease and perinatal outcome of 19 pregnancies in 16 patients with idiopathic thrombocytopenic purpura was studied. Results. Out of 16 patients with idiopathic thrombocytopenic purpura, eight were already diagnosed while the other eight were diagnosed during pregnancy. Five patients diagnosed during pregnancy had severe thrombocytopenia, and four of them showed hemorrhagic manifestation. Nine patients required steroids during pregnancy. Two patients received immunoglobulin therapy. During the antenatal period one patient developed pre-eclampsia and one patient had gestational diabetes mellitus. Both of these patients were on steroids. There was no postpartum hemorrhage or maternal death. None of the neonates had bleeding complication, irrespective of mode of delivery. Conclusion. Pregnant patients with idiopathic thrombocytopenic purpura have generally good maternal and perinatal outcomes.
Pregnancy and Birth Outcomes among Women with Idiopathic Thrombocytopenic Purpura
Journal of pregnancy, 2016
Objective. To examine pregnancy and birth outcomes among women with idiopathic thrombocytopenic purpura (ITP) or chronic ITP (cITP) diagnosed before or during pregnancy. Methods. A linkage of mothers and babies within a large US health insurance database that combines enrollment data, pharmacy claims, and medical claims was carried out to identify pregnancies in women with ITP or cITP. Outcomes included preterm birth, elective and spontaneous loss, and major congenital anomalies. Results. Results suggest that women diagnosed with ITP or cITP prior to their estimated date of conception may be at higher risk for stillbirth, fetal loss, and premature delivery. Among 446 pregnancies in women with ITP, 346 resulted in live births. Women with cITP experienced more adverse outcomes than those with a pregnancy-related diagnosis of ITP. Although 7.8% of all live births had major congenital anomalies, the majority were isolated heart defects. Among deliveries in women with cITP, 15.2% of live...
Fetal Diagnosis and Therapy, 2009
in women in the general population is estimated to be 11.3 per 100,000 [1] , but ITP is more common in pregnancy, where approximately 2 per 1,000 pregnancies are affected [2]. ITP may be diagnosed for the first time in pregnancy and pre-existing ITP may be exacerbated in pregnancy [3]. The pathogenic anti-platelet antibodies may cross the placenta and, in a minority of cases, cause severe neonatal thrombocytopenia, which may be complicated by intracranial haemorrhage [4-6]. Unfortunately, it remains difficult to predict which neonates are at risk of severe thrombocytopenia, as there is poor correlation between the maternal and neonatal platelet counts [3, 7, 8]. Direct measurement of the fetal platelet count is not commonly done because this poses significant risks of morbidity and mortality to the fetus [9-11]. Studies examining potential maternal predictors of neonatal thrombocytopenia have not identified clear risk factors. In addition, the appropriate antenatal treatment of neonates at risk of passive thrombocytopenia is also controversial. Treatment options include antenatal maternal corticosteroids, intravenous immunoglobulin (IVIG), splenectomy or no medical intervention. We report the case of a woman with chronic ITP previously treated with splenectomy, who had a prior infant severely affected with passive thrombocytopenia and whose subsequent pregnancy was managed successfully