Primary thrombocythemia and pregnancy: Treatment and outcome in fifteen cases

Abstract

Pregnancy in patients with primary thrombocythemia (PT) is reported to be often complicated by recurrent abortion and fetal growth retardation. Fifteen pregnancies in nine patients with PT are reported. Nine pregnancies had a good outcome, with the birth of a healthy infant. There were two spontaneous abortions and three intrauterine deaths. One pregnancy was electively terminated after extensive thrombosis in the splanchnic district requiring surgical entero‐resection. In five pregnancies the mother received no treatment; in ten pregnancies acetylsalicylic acid (ASA) was prescribed to the mother as soon as she was found pregnant, subcutaneous heparin was added from the middle trimester in seven cases. In patients treated with ASA and subcutaneous heparin pregnancies had a good outcome. Administration of ASA and heparin during pregnancy appears to improve the outcome in patients with PT and can prevent severe maternal complications, but requires close monitoring. © 1996 Wiley‐Liss, Inc.

Pregnancy complications predict thrombotic events in young women with essential thrombocythemia

“…A number of studies have shown that women with ET are at higher risk of developing pregnancy complications and placental thrombosis has been documented in cases complicated by late fetal loss , preterm delivery , and IUGR .…”

“…Key factors influencing pregnancy outcome include an adequate placental development and the maintenance of a normal uterine blood flow. Thromboses can occur in any vessel in MPN patients, including the placental vessels, as documented in patients with late fetal loss, preterm delivery , and intrauterine growth restriction (IUGR) . As a higher incidence of thromboembolic events and pregnancy complications are both associated with MPN, the possibility of a relationship between these complications is a matter of concern.…”

Essential thrombocythemia

“…However, demonstration of a significantly better outcome of pregnancies evolving under continuous aspirin treatment has not been confirmed by a recent report [6]. Some studies have suggested that aspirin from the onset of pregnancy plus heparin from the second trimester might improve pregnancy outcome [79]. …”

Pregnancy and its management in the Philadelphia negative myeloproliferative diseases

“…However, given the expanding literature for pregnancy management in both antiphospholipid syndrome and/or inherited thrombophilia favouring active treatment of patients with prior pregnancy events, it would be difficult to justify not offering ET patients with previous pregnancy complications similar therapy. Although the largest series of patients published to date failed to provide support for a beneficial influence of aspirin therapy even in patients with pregnancy losses (Wright & Tefferi, 2001); others have suggested that aspirin from the outset of pregnancy with heparin from the second trimester might improve pregnancy outcome (Pagliaro et al , 1996). Overall, Griesshammer et al (2003) suggested that the success rate in 68 patients treated with aspirin (some in combination with other drugs) was 46 of 68 (68%) live births.…”

“…Histological review has also demonstrated intervillous and spiral vessel thrombosis in haematologically normal females with this spectrum of serious pregnancy complications. In patients with ET placental thrombosis has been documented in cases complicated by late fetal loss (Pagliaro et al , 1996), pre‐term delivery (Pagliaro et al , 1996) and IUGR (Falconer et al , 1987). In MPDs the mechanism of the acquired prothrombotic state differs from other thrombophilias.…”