Contraverted questions of management of pregnancy with immune thrombocytopenia

Abstract

Among autoimmune cytopenias during pregnancy, immune thrombocytopenia (ITP) occurs most often. Thrombocytopenia (TP), a decrease in platelet count less than 150x109/l, occurs in 5 to 12% of pregnancies. Immune thrombocytopenia is a diagnosis of exclusion and requires differential diagnosis primarily with gestational TP. Preconception counseling is extremely important in ITP to develop an individual pregnancy management plan. Prediction and calculation of antero-, perinatal and obstetric risks for the fetus and pregnant woman should be performed repeatedly during pregnancy. The choice of the time of initiation of therapy and the type of medication is not clear due to the specificity of the drugs and the possible impact on the fetus. The issue of neonatal severe thrombocytopenia and hemorrhagic complications that may occur at the antenatal stage in some cases is not explained by maternal immune thrombocytopenia, and fetal3neonatal alloimmune thrombocytopenia (FNAT). An unambiguous guide to the prevention and management of cases with FNAT has not been developed at present. We have highlighted current global trends on this issue. Pregnant women with severe TP are a group of high perinatal risk, pregnancy and childbirth should take place in a maternity hospital of III level with the involvement of a multidisciplinary team and an individual plan of pregnancy management, development of delivery and management of postpartum and neonatal periods. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: immune thrombocytopenia, pregnancy, fetal-neonatal alloimmune thrombocytopenia, gestational thrombocytopenia.