Fetal Hydrocephalus in a Pregnancy Complicated by Idiopathic Thrombocytopenic Purpura

Kim, Min Woo; Choi, Heekyu

doi:10.7863/jum.2006.25.6.777

Cited by 7 publications

(5 citation statements)

References 12 publications

(12 reference statements)

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Maternal Itp Refractory To Splenectomymentioning

confidence: 86%

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

et al. 2011

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Of infants born to women with idiopathic thrombocytopenic purpura (ITP), about 10-15% have transient neonatal immune thrombocytopenic purpura (NITP). Of concern is the lack of a reliable predictor for NITP. We conducted a retrospective study of all pregnancies with ITP at Osaka University Hospital over the past 16 years analyzing a total of 127 pregnancies in 88 women with ITP to assess the predictive value of various clinical factors regarding neonatal platelet count in the current pregnancy. We also reviewed the literature concerning ITP in pregnancy and NITP prediction. Neonatal platelet counts were less than 100 3 10 9 /L in 20 of 130 neonates (15.4%), less than 50 3 10 9 /L in 11 neonates (8.5%), and less than 20 3 10 9 /L in three neonates (2.3%). There was a strong correlation between the first and second sibling regarding the occurrence and the severity of NITP with Spearman correlation coefficient of 0.55 (P 5 0.001) at birth and 0.63 (P < 0.0001) at nadir after birth. A maternal platelet count less than 100 3 10 9 /L at delivery showed a statistical trend for an association with the occurrence of NITP (P 5 0.043). Moreover, maternal ITP refractory to splenectomy correlated with a higher risk for fetal or neonatal ICH according to the review of the literature. In conclusion, pregnant women who have had a previous offspring with NITP or who have ITP refractory to splenectomy may be at particular risk of delivering an offspring with significant NITP. Management decisions, including mode of delivery, may be altered by the degree of risk for potentially severe NITP. Am. J. Hematol. 87:15-21, 2012. V

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Section: Resultsmentioning

confidence: 99%

Section: Maternal Itp Refractory To Splenectomymentioning

confidence: 86%

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

et al. 2011

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“…Hydrocephalus can occur as a rare complication of intracranial hemorrhage in fetuses born to mothers with ITP [ 20 ]. Kim and Choi [ 21 ] described a neonate with severe thrombocytopenia (platelet count 1 × 10 9 /L), multiple bruises on the face and scalp, widespread petechiae, cleft palate, and moderate to severe hydrocephalus without evidence of intraventricular hemorrhage. Computerized tomography confirmed severe hydrocephalus without significant compression of the brain parenchyma, diffuse ischemia, and encephalomalacia of both cerebral hemispheres.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy and Birth Outcomes among Women with Idiopathic Thrombocytopenic Purpura

Wyszynski

Carman

Cantor³

et al. 2016

Journal of Pregnancy

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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 births were preterm. Conclusions. The results of this study provide further evidence that cause and duration of maternal ITP are important determinants of the outcomes of pregnancy.

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“…In Case 3, the association of epignathus and hydrocephalus appears to be entirely coincidental; no similar cases could be found in the literature. Other maternal factors, such as vasoactive and anticoagulant drugs, thrombocytopenia and other coagulopathies, pre-eclampsia, infections and even minor abdominal trauma are recognized risk factors for fetal intracranial hemorrhage (20,21,37,38). Case 2 is more problematic as it is obviously syndromic.…”

Section: Discussionmentioning

confidence: 99%

“…Another possible explanation for bleeding is the poorly controlled maternal diabetes, which can cause impaired fetal blood clotting (35). Other maternal factors, such as vasoactive and anticoagulant drugs, thrombocytopenia and other coagulopathies, pre-eclampsia, infections and even minor abdominal trauma are recognized risk factors for fetal intracranial hemorrhage (20,21,37,38).…”

Section: Discussionmentioning

confidence: 99%

Fetal Hydrocephalus Caused by Cryptic Intraventricular Hemorrhage

Lategan¹,

Chodirker

Bigio³

2010

Brain Pathology

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Cryptic intracerebral hemorrhage as an etiological factor in fetal hydrocephalus has been postulated but not described at autopsy. Four fetuses with overt hydrocephalus diagnosed by in utero ultrasound examination were examined at autopsy at 19-22 weeks gestation. Although a hemorrhagic etiology was not evident on ultrasound, hemosiderin-containing macrophages and associated reactive changes were found to obstruct the otherwise well-formed cerebral aqueduct in all four. Coagulopathy due to thrombocytopenia was implicated in one case. Anomalies involving other parts of the body were identified in two cases, although a direct link to the hydrocephalus was not obvious. The abnormality was isolated in one case. In three cases, possible sites of hemorrhage in the ventricles were identified. This abnormality represents a significant proportion of the fetuses examined for hydrocephalus in our referral center. We discuss the importance of careful autopsy examination in the diagnosis of cryptic intracerebral hemorrhage and the implications for counseling.

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Fetal Hydrocephalus in a Pregnancy Complicated by Idiopathic Thrombocytopenic Purpura

Cited by 7 publications

References 12 publications

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

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

Pregnancy and Birth Outcomes among Women with Idiopathic Thrombocytopenic Purpura

Fetal Hydrocephalus Caused by Cryptic Intraventricular Hemorrhage

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