Thrombocytopenia in pregnancy: do the time of diagnosis and delivery route affect pregnancy outcome in parturients with idiopathic thrombocytopenic purpura?

Abstract

The objective of this study was to investigate the determining effects of diagnosis time on pregnancy outcomes in a population of pregnant women with idiopathic thrombocytopenic purpura (ITP). Records of all the pregnant women with thrombocytopenia were evaluated. Those with a confirmed diagnosis of ITP were included in the study. Main outcome measures were antenatal thrombocyte count, postpartum haemorrhage rate, and route of delivery. Foetal outcomes such as foetal thrombocyte count, haemorrhage, and birth weight were also reported as secondary outcome measures. Time of diagnosis either antenatal or preconception did not significantly alter the investigated parameters. Delivery route had no impact on complication rates. Time of diagnosis also did not affect treatment modality. ITP is rare disorder accounting for less than 5 % of all pregnant thrombocytopenias. Time of diagnosis does not affect maternal-foetal outcomes or treatment modality unless diagnosis is made during labour. Compared to gestational thrombocytopenia, treatment rates may differ but treatment modalities remain the same and the effort put into making the differential should be weighed against maternal stress factors for lengthy laboratory evaluation as long as the thrombocytopenia is of pure nature without any systemic involvement.

Maternal and fetal outcome among pregnant women presenting with thrombocytopenia

“…11 The incidence of fetal thrombocytopenia was higher in the studies of Yuce et al (14%), Yassaee et al (10.50%) and Bhat et al (36.10%) and difference were statistically significant. 23,28 [9][10][11]14,21 In the present study HELLP syndrome was seen in 1.50% of the thrombocytopenic women which was statistically similar to the study by Turgot et al (1.14%), Habas et al (0.37%) and Vyas et al (4.08%). 9,18,19,30 Whereas studies by Parnas et al and Onisai et al showed HELLP syndrome in 12.06% and 9.52% women respectively, which was higher than our study.…”

“…9,11,20 Whereas the incidence of LSCS was higher in the studies conducted by Pafumi et al (55%) and Yuce et al (56%). 28,31 In the present study 4.60% subjects required blood transfusion. However, the need for blood transfusion was higher in the studies by Parnas et al (16.60%), Borna et al (26.20%), Yuce et al (10%) and Dwivedi et al (9.0%).…”

“…However, the need for blood transfusion was higher in the studies by Parnas et al (16.60%), Borna et al (26.20%), Yuce et al (10%) and Dwivedi et al (9.0%). 8,17,21,28 In the present study, 30% of thrombocytopenic women required induction of labour for various obstetrical indications. In the study by Parnas et al 27.20% women required induction of labour which was comparable to our study (p value 0.571 statistically non-significant).…”

Management of immune-mediated cytopenias in pregnancy

“…Of the 25% of women who underwent cesarean section, thrombocytopenia was cited as the indication in only 7% of deliveries (n = 2) [9]. In several retrospective studies, hemorrhagic complications were uncommon in the mother or neonate and were not related to the mode delivery or maternal platelet count [9,[32][33][34][35].…”

Pregnancy of patients with idiopathic thrombocytopenic purpura: maternal and neonatal outcomes

“…Gestational thrombocytopenia, which usually occurs in the midsecond to third trimester and which is a mild form with platelet counts more than 70x10 3 /μL, constitutes 70-80% of cases (1,5). ITP, which is an autoimmune disease with autoantibodies against the platelet membrane causing platelet destruction in the reticuloendothelial system, must be considered in the differential diagnosis.…”