A retrospective 11-year analysis of obstetric patients with idiopathic thrombocytopenic purpura

• Published in: Blood Vol. 102; no. 13; pp. 4306 - 4311
• Main Authors: Webert, Kathryn E., Mittal, Richa, Sigouin, Christopher, Heddle, Nancy M., Kelton, John G.
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 15.12.2003; The Americain Society of Hematology
• Subjects: Adrenal Cortex Hormones - therapeutic use; Adult; Analgesia, Epidural - statistics & numerical data; Analgesia, Obstetrical - statistics & numerical data; Biological and medical sciences; Cesarean Section - statistics & numerical data; Delivery, Obstetric - statistics & numerical data; Diseases of mother, fetus and pregnancy; Female; Fetal Death - etiology; Gynecology. Andrology. Obstetrics; Hematologic and hematopoietic diseases; Hemorrhage - epidemiology; Hemorrhage - etiology; Humans; Immunoglobulins, Intravenous - therapeutic use; Immunosuppressive Agents - therapeutic use; Infant, Newborn; Medical sciences; Platelet diseases and coagulopathies; Pregnancy; Pregnancy Complications, Hematologic - drug therapy; Pregnancy Complications, Hematologic - epidemiology; Pregnancy Outcome; Pregnancy, Multiple; Pregnancy. Fetus. Placenta; Purpura, Thrombocytopenic, Idiopathic - complications; Purpura, Thrombocytopenic, Idiopathic - drug therapy; Purpura, Thrombocytopenic, Idiopathic - epidemiology; Retrospective Studies; Thrombocytopenia - congenital; Treatment Outcome; Pregnancy; Human; Immunopathology; Platelet; Prognosis; Essential thrombocytopenia; Hematology; Hemopathy; Maternal diseases; Immune thrombocytopenic purpura
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2002-10-3317

Numerous studies have examined the outcomes of infants born to mothers with idiopathic thrombocytopenic purpura (ITP). Fewer studies have discussed the morbidity of obstetric patients with ITP. We describe a retrospective study of 92 women with ITP during 119 pregnancies over an 11-year period. Most women had thrombocytopenia during pregnancy. At delivery, women in 98 pregnancies (89%) had platelet counts lower than 150 × 109/L; most had mild to moderate thrombocytopenia. For many, the pregnancy was uneventful; however, women had moderate to severe bleeding in 25 pregnancies (21.5%). Women in 37 pregnancies (31.1%) required treatment to increase platelet counts. During delivery, 44 women (37.3%) received epidural analgesia without complications, with most having a platelet count between 50 and 149 × 109/L. Most deliveries (82.4%) were vaginal. Bleeding was uncommon at delivery. Infant platelet counts at birth ranged from 12 to 436 × 109/L; 25.2% of infants had platelet counts lower than 150 × 109/L, and 9% had platelet counts lower than 50 × 109/L. Eighteen infants (14.6%) required treatment for hemostatic impairment. Two fetal deaths occurred. One was caused by hemorrhage. ITP in pregnancy carries a low risk, but mothers and infants may require therapy to raise their platelet counts. (Blood. 2003;102:4306-4311)