Objective To describe the outcome of pregnancies with fetal and neonatal alloimmune thrombocytopenia (FNAIT) in relation to the invasiveness of the management protocol.Design Retrospective analysis of prospectively collected data from a national cohort.Setting Leiden University Medical Centre, the national centre for management of severe red cell and platelet alloimmunisation in pregnancy.Population Ninety-eight pregnancies in 85 women with FNAIT having a previous child with thrombocytopenia with (n = 16) or without (n = 82) an intracranial haemorrhage (ICH).Methods Our management protocol evolved over time from (1) serial fetal blood samplings (FBS) and platelet transfusion (n = 13) via (2) combined FBS with maternal intravenous immunoglobulins (n = 33) to (3) completely noninvasive treatment with immunoglobulins only (n = 52 pregnancies, resulting in 53 neonates). Perinatal outcome was assessed according to the three types of management.Main outcome measures Occurrence of ICH, perinatal survival, gestational age at birth and complications of FBS.Results All but one of 98 pregnancies ended in a live birth; none of the neonates had an ICH. The median gestational age at birth was 37 weeks (range 32-40). In groups 1 and 2, three emergency caesarean sections were performed after complicated FBS, resulting in two healthy babies and one neonatal death.Conclusion Noninvasive antenatal management of pregnancies complicated by FNAIT appears to be both effective and safe.

Satisfaction with pain relief is higher in women receiving epidural analgesia compared with Remifentanil PCA.

Objective To examine (1) the incidence of fetal thrombocytopenia in hydropic fetuses with congenital B19 virus infection, (2) the effect of intrauterine platelet transfusions and (3) the correlation between fetal B19 viral load and severity of thrombocytopenia.Design Retrospective analysis of data from prospectively collected fetal blood samples.Setting Leiden University Medical Centre, the national centre for management of intrauterine fetal disease in the Netherlands.Population Thirty hydropic fetuses treated with intrauterine red blood cell and platelet transfusions for human B19 virus-induced severe fetal anaemia and thrombocytopenia over a 10-year period.Methods Fetal blood samples (n = 30) taken before and after intrauterine transfusion were investigated. No cases were excluded, and there was no loss to follow up.Main outcome measures Parameters recorded were gestational age, experienced fetal movements, gravidity and parity, severity of fetal hydrops, severity of fetal anaemia and thrombocytopenia and megakaryocyte and reticulocyte counts. Survival and procedureassociated complications were documented. Quantitative B19 viral load measurements were performed on all fetal samples.Results Forty-six percent of all hydropic fetuses showed severe thrombocytopenia. No antenatal intracerebral haemorrhage or procedure-associated bleeding occurred. Overall, survival was 77%. Platelet counts increased following platelet transfusion and decreased significantly following red blood cell transfusion alone. No correlation was found between fetal viral loads and platelet counts.Conclusion Thrombocytopenia was frequently encountered in fetal B19V infection, but fetal bleeding complications were not noted. Absence of a direct relationship between fetal B19 viral load and platelet counts suggests a temporal dissociation between these findings. Dilutional thrombocytopenia is frequently seen in the fetus following red blood cell transfusion alone. The clinical significance of this phenomenon is unclear. The risk of fluid overload by fetal platelet transfusion in a severely hydropic fetus should be weighed against the low incidence of fetal bleeding complications.

In pregnancies with FNAIT and a thrombocytopenic sibling without ICH, vaginal delivery was not associated with neonatal intracranial bleeding. These initial results support our noninvasive management of these pregnancies with FNAIT.