Immunological Thrombocytopenia in Pregnancy

Patriarco, Michael; Yeh, Shih-Ching

doi:10.1097/00006254-198611000-00001

Cited by 7 publications

(1 citation statement)

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“…The major risk associated with AITP in pregnancy is to the fetus 14 . Reported perinatal mortality has varied widely, but is probably of the order of 5%, 15 and is largely due to intracerebral haemorrhage secondary to neonatal thrombocytopenia. There is also an increased risk of spontaneous abortion 16 .…”

Section: Discussionmentioning

confidence: 99%

SLE‐ASSOCIATED THROMBOCYTOPENIA IN PREGNANCY: SUCCESSFUL OUTCOME WITH COMBINED IgG INFUSION AND PLATELET TRANSFUSION

1993

Int J Clinical Practice

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SUMMARY Autoimmune thrombocytopenia presents special problems during pregnancy because of the limited therapeutic options and the risks posed by even moderate degrees of thrombocytopenia. Although corticosteroids and intravenous immunoglobulin G (IV IgG) have been shown to be useful and relatively safe therapies, they are not always effective. We describe a patient with systemic lupus erythematosus (SLE) who developed severe thrombocytopenia unresponsive to prednisone and IV IgG. The combination of IV IgG and platelet transfusion immediately before delivery resulted in a rapid rise in platelet count and allowed a lower segment caesarean section to be undertaken without perioperative complication.

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Section: Discussionmentioning

confidence: 99%

SLE‐ASSOCIATED THROMBOCYTOPENIA IN PREGNANCY: SUCCESSFUL OUTCOME WITH COMBINED IgG INFUSION AND PLATELET TRANSFUSION

1993

Int J Clinical Practice

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ITP in pregnancy and the newborn: Introduction

Sacher

1989

Blut

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Idiopathic thrombocytopenic purpura (ITP) occurs more commonly in young women and is one of the commonest immune mediated disorders in pregnancy. It may exist as an incidental finding in an otherwise healthy pregnant woman or may be associated with symptomatic reduction in the platelet count and varying degrees of clinical hemorrhage. The condition termed incidental thrombocytopenia of pregnancy is invariably associated with a platelet count of greater than 100 x 10(9)/L and a very low incidence of fetal thrombocytopenia. Symptomatic thrombocytopenia is more commonly associated with low platelet counts in the fetus (estimated between 20%-40%). It has recently been suggested that the incidence of fetal thrombocytopenia is substantially lower than this figure. The management of ITP in pregnancy is complicated by the fact that fetal thrombocytopenia is difficult to diagnose and carries substantial risks during the delivery process with rare cases of fetal hemorrhage occurring spontaneously in utero. Unfortunately there are no laboratory studies that can be performed precisely in the mother that may predict the occurrence of fetal thrombocytopenia. Maternal management is usually directed towards treatment of maternal symptoms. Maternal treatment or response to treatment is inconsistently associated with predictable changes in the fetal platelet count. Obstetric management is aimed at reducing the risks of life threatening fetal hemorrhage occurring at the time of delivery, and fetal management is directed towards the obtaining of fetal platelet samples in order to plan an appropriate strategy for obstetrical delivery. Fetal blood samples are obtained either by a scalp vein puncture at the time of delivery or earlier in gestation by the use of the newer technique termed percutaneous umbilical blood sampling. Fetuses with platelet counts of less then 50 x 10(9)/L are generally delivered by cesarean section whereas those with counts greater than 50 x 10(9)/L are allowed to proceed with vaginal delivery assuming no obstetrical contraindications exist. The use of IVIgG therapy during pregnancy has theoretical implications on improving platelet counts in the mother in situations of severe hemorrhage, however cannot be considered to be appropriate treatment for the prevention of fetal thrombocytopenia, since the exogenous transport of IVIgG across the placenta appears to be inconsistent and unpredictable.(ABSTRACT TRUNCATED AT 400 WORDS)

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Perinatal diagnosis of passive ITP: Use of percutaneous umbilical blood sampling (PUBS)

Sacher

King

1989

Blut

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Fetal blood samples can be obtained in utero by direct sampling of the umbilical cord vessels, using an ultrasound guided technique termed percutaneous umbilical sampling (PUBS). This procedure is being used more frequently in high risk pregnancies to obtain direct fetal laboratory data. In specialized centers, with trained personnel, the technique can be used with a high degree of safety and efficiency. Direct access to the fetal circulation can also allow an accurate determination of the fetal platelet count in cases of suspected fetal thrombocytopenia. The technique may be used to plan appropriate clinical management of maternal ITP as well as to diagnose the presence of fetal alloimmune thrombocytopenia. A logical strategy for obstetric management and evaluation of fetal risk can be planned. The procedure also has the potential to allow direct fetal treatment as has been the case in the management of severe fetal anemia.

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Immunological Thrombocytopenia in Pregnancy

Cited by 7 publications

References 0 publications

SLE‐ASSOCIATED THROMBOCYTOPENIA IN PREGNANCY: SUCCESSFUL OUTCOME WITH COMBINED IgG INFUSION AND PLATELET TRANSFUSION

SLE‐ASSOCIATED THROMBOCYTOPENIA IN PREGNANCY: SUCCESSFUL OUTCOME WITH COMBINED IgG INFUSION AND PLATELET TRANSFUSION

ITP in pregnancy and the newborn: Introduction

Perinatal diagnosis of passive ITP: Use of percutaneous umbilical blood sampling (PUBS)

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