Severe Primary Autoimmune Thrombocytopenia in Pregnancy: A National Cohort Study

Abstract

(BJOG. 2018;125:604–612) Primary autoimmune thrombocytopenia (ITP) is an acquired autoimmune disease that is commonly detected in women of reproductive age. ITP is a hemorrhagic disorder characterized by a decrease in platelet count that can carry an increased risk of bleeding. ITP has been reported to occur in 1 in 1000 to 1 in 10,000 pregnancies, but determining the incidence of severe ITP is challenging due to the rarity of the disorder, changing diagnostic criteria, and difficulty determining the cause of thrombocytopenia. The authors hypothesized the risks of maternal and neonatal morbidity and mortality would be elevated in parturients with ITP. This study aimed to determine the incidence of severe ITP in pregnancy in the United Kingdom, as well as current management strategies and maternal and fetal outcomes.

Bleeding Complications Associated with Pregnancy with Primary Immune Thrombocytopenia: A Meta-Analysis

“…Information regarding the mode of delivery in mothers with ITP was provided in 10 articles ( Table 4 ). Vaginal delivery was far more common (>60%) in six of them, 14 16 17 18 21 22 but two studies reported cesarean sections in more than 75% of the cases. 19 28 In one of these latter two studies, which considered 17 labors, the authors stated that, when chosen, this procedure was always performed for obstetric reasons.…”

“…1 ). 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Table S1 (available in the online version) depicts the chosen studies and includes information concerning their aims and the topics addressed. Among the variables addressed by this review, only the maternal and neonatal mortality were addressed in all the 15 selected articles.…”

“…Six studies addressed maternal bleeding during pregnancy, 14 16 17 18 20 25 in which bleeds, irrespective of severity, were reported in 8 to 54% of cases ( Table 1 ). Most bleeding episodes were minor.…”

“…In the other three cohorts, the incidence ranged between 5 and 20%. 14 16 19 The weighted event rate for severe postpartum hemorrhage was 0.053 (95% CI, 0.020–0.134).…”

“…19 Of the other articles that described the reasons underlying the choice of delivery mode, one reported 42 cesareans, all of which were performed in light of obstetric indications. 16 In another study, 2 of the 16 reported cesarean sections were performed because of an ITP indication, namely the concern about low neonatal platelet counts. 14 In another cohort, 18 cesareans were performed for obstetric reasons but the other seven were done because of a diagnosis of severe thrombocytopenia in the fetus.…”