A retrospective 11-year analysis of obstetric patients with idiopathic thrombocytopenic purpura

Abstract

Numerous studies have examined the outcomes of infants born to mothers with idiopathic thrombocytopenic purpura (ITP). Fewer studies have discussed the morbidity of obstetric patients with ITP. We describe a retrospective study of 92 women with ITP during 119 pregnancies over an 11-year period. Most women had thrombocytopenia during pregnancy. At delivery, women in 98 pregnancies (89%) had platelet counts lower than 150 ؋ 10 9 /L; most had mild to moderate thrombocytopenia. For many, the pregnancy was uneventful; however, women had moderate to severe bleeding in 25 pregnancies (21.5%). Women in 37 pregnancies (31.1%) required treatment to increase platelet counts. During delivery, 44 women (37.3%) received epidural analgesia without complications, with most having a platelet count between 50 and 149 ؋ 10 9 /L. Most deliveries (82.4%) were vaginal. Bleeding was uncommon at delivery. Infant platelet counts at birth ranged from 12 to 436 ؋ 10 9 /L; 25.2% of infants had platelet counts lower than 150 ؋ 10 9 /L, and 9% had platelet counts lower than 50 ؋ 10 9 /L. Eighteen infants (14.6%) required treatment for hemostatic impairment. Two fetal deaths occurred. One was caused by hemorrhage. ITP in pregnancy carries a low risk, but mothers and infants may require therapy to raise their platelet counts. ( IntroductionIdiopathic thrombocytopenic purpura (ITP) frequently occurs in young women. Consequently, hematologists often treat pregnant women who have a diagnosis or a history of ITP. 1 It is now recognized that, in many patients, the disease is caused by platelet autoantibodies that can cross the placenta and produce thrombocytopenia in some infants. 2 In the past decade, our understanding of ITP in pregnancy has improved; however, in almost all studies, the focus has been on the infant. We now recognize that most of these infants do not have severe thrombocytopenia and that they can be safely delivered vaginally. 3 There has not been much information about ITP outcomes in obstetric patients, including their hemostatic risk at delivery and the likelihood of needing treatment during pregnancy. For this reason, we reviewed the outcomes of pregnant patients with ITP treated over a period of 11 years in the 2 obstetric units of Hamilton hospitals affiliated with McMaster University. We found that mothers with very low platelet counts can successfully deliver healthy infants and that though maternal and fetal bleeding can occur, such complications are uncommon. Patients, materials, and methodsA retrospective chart review was performed for all obstetric patients with ITP who were treated and delivered at the 2 hospitals with obstetric services in Hamilton, Ontario, from January 1, 1990, to December 31, 2000. Patients were eligible for the study if they met the inclusion criteria of pregnancy with a diagnosis of ITP or pregnancy with a previous history of ITP. They were considered to have ITP if they had a history of thrombocytopenia for which other causes were excluded. Other causes of thrombocytopenia included sepsis, pre...

Reliable predictors of neonatal immune thrombocytopenia in pregnant women with idiopathic thrombocytopenic purpura

“…Additionally, searching for reliable predictors of NITP, we conducted a review of a total of 22 reported cases of fetal or neonatal ICH with NITP secondary to maternal ITP published from 1960 to 2010 [4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The result was summarized in Table IV.…”

“…In contrast, Payne et al reported that maternal history of splenectomy was significantly correlated with severe NITP (odds ratio: 5.63, confidence interval 2.2-14.3) [4] and this conclusion was also derived from a larger retrospective study including 284 pregnancies with ITP and 286 neonates by Fujimura et al [33]. According to the review of cases of fetal or neonatal ICH secondary to maternal ITP (Table IV) [4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], it is reasonable to consider that maternal ITP refractory to splenectomy may have a potential risk to induce more serious NITP and increase the incidence of fetal or neonatal ICH. This new insight has never been pointed out before, but is interesting and noteworthy.…”

“…Recently, Roberts et al mentioned in their review of neonatal thrombocytopenia that the severity of maternal thrombocytopenia during pregnancy or the occurrence of severe thrombocytopenia in a previous neonate are the most useful parameters for predicting the occurrence of NITP [30]. Some literature also supported the hypothesis of the correlation between the severity of maternal thrombocytopenia and the occurrence of NITP [20,31,32]. This agenda remains debatable in the future.…”

Prevalence and Characterization of Thrombocytopenia in Pregnancy in Indian Women

“…ACOG [17] recommended serial assessment of the maternal platelet count in every trimester for asymptomatic women in remission and more frequently for thrombocytopenic cases of ITP. Kathryn et al [22] stated that therapy for pregnant mothers with ITP is similar to that for non-pregnant patients. Treatment is recommended when the platelet count is unacceptably low or when the patient has symptoms, such as petechiae or mucosal bleeding [23,24].…”

Anaesthesia for Caesarean Section of Pregnant Women with Idiopathic Thrombocytopenic Purpura

“…Therefore, women with a history of ITP or those who were diagnosed with ITP during pregnancy require anaesthesia for caesarean section or natural birth (1). ITP does not affect normal foetal development and does not cause postpartum haematological complications in newborns.…”