Pregnancy in patients with autoimmune thrombocytopenic purpura

Noriega-Guerra, L; Avilés-Miranda, A; Cadena, O Alvarez de la; Espinosa, Luz María; Chávez, Francisco; Pizzuto, J

doi:10.1016/0002-9378(79)90068-1

Cited by 32 publications

(3 citation statements)

References 13 publications

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“…In this series the overall rate of fetal thrombocytopenia in pregnant women with AITP was 12.5%, in good agreement with previous studies ( Samuels et al , 1990 ; Burrows & Kelton, 1990b; Kaplan et al , 1990 ; Garmel et al , 1995 ; Paynes et al , 1997 ). Our results also confirm that maternal platelet counts at birth do not correlate with the infant platelet count at birth, as previously demonstrated ( Noriega‐Guerra et al , 1979 ; Scott et al , 1980 ; Kelton, 1983; Burrows & Kelton, 1990b; Samuels et al , 1990 ; Kaplan et al , 1990 ; Cook et al , 1991 ; Yamada & Fujimoto, 1994). However, considering that the most thrombocytopenic mothers are likely to have received effective treatments in order to correct thrombocytopenia towards the end of pregnancy (corticoids or immunoglobulins), we compared the infant platelet count at birth to the nadir maternal platelet count during the index pregnancy.…”

Section: Discussionsupporting

confidence: 92%

Relationships between severe neonatal thrombocytopenia and maternal characteristics in pregnancies associated with autoimmune thrombocytopenia

Valat¹,

Caulier²,

Devos

et al. 1998

Br J Haematol

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Summary.In pregnant women with antecedents of autoimmune thrombocytopenia (AITP), no predictive factor for severe fetal thrombocytopenia has been identified. We evaluated the relationships between the course of the maternal disease before and during pregnancy and the risk of severe fetal thrombocytopenia, in 64 pregnant women with known chronic AITP antecedents, over a 12-year period. 28 pregnant women had undergone splenectomy before pregnancy and 17 experienced severe thrombocytopenia (< 50 × 10 9 /l) during pregnancy (monthly determination). Eight infants presented with severe thrombocytopenia at birth (12·5%), and four in the following days (6·25%). No severe haemorrhage was observed. Severe thrombocytopenia at birth was present in 57% (CI 95% 18-90%) of the infants born to mothers with severe pregnancy-associated thrombocytopenia and splenectomy antecedents, and in 0% (CI 95% 0-15%) of the infants born to mothers who presented none of these antecedents (P ¼ 0·001). In thrombocytopenic mothers the infant platelet counts at birth were positively correlated to the nadir maternal platelet count during the index pregnancy (r ¼ 0·42, P ¼ 0·0075).These results suggest that severe autoimmune disease is a risk factor for severe fetal thrombocytopenia, and that pregnant women with no antecedent of splenectomy nor severe thrombocytopenia during pregnancy have a very low risk of severe fetal thrombocytopenia.

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Section: Discussionsupporting

confidence: 92%

Relationships between severe neonatal thrombocytopenia and maternal characteristics in pregnancies associated with autoimmune thrombocytopenia

Valat¹,

Caulier²,

Devos

et al. 1998

Br J Haematol

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“…The vast majority of fetuses will have platelet counts greater than 50 K, allowing most mothers to deliver vaginally without the risk of intracranial haemorrhage. Correlation between maternal and fetal platelet counts is poor (Samuels et al, 1990;Scott, 1994;Laros and Kagan, 1984;Murray and Harris, 1976;Cines et al, 1982;Noriega-Guerra, 1979;Kelton, 1983) and there is currently no non-invasive way to identify fetuses at risk. Determination can be done by either fetal scalp blood sampling in labour or by percutaneous umbilical blood sampling.…”

Section: Discussionmentioning

confidence: 99%

The Role of Percutaneous Umbilical Blood Sampling in the Management of Immune Thrombocytopenic Purpura

Garmel

Craigo

Morin

et al. 1996

Obstetrical & Gynecological Survey

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On consultation, percutaneous umbilical blood sampling (PUBS) was offered to women with immune thrombocytopenic purpura (ITP) to determine the mode and site of delivery prior to labour. Between January 1989 and December 1993,41 pregnant women underwent PUBS. All women had a history of ITP, a platelet count less than 90 K, (+) antiplatelet antibody, and/or thrombocytopenia diagnosed early in pregnancy. PUBS was performed at term except in one patient with preterm labour, who underwent PUBS at 31 weeks' gestation. Patients with fetal platelet counts greater than 50 K returned to their referring physician for delivery. Records were complete in 39 pregnancies. Fetal blood was successfully obtained in 37 of 39 cases (95 per cent). Fetal-platelet counts correlated with neonatal platelet counts in 36 of 37 cases (97 per cent). The interval between PUBS and delivery ranged from 0 to 31 days. Six of 37 fetuses (16 per cent) had significant fetal thrombocytopenia (<50 K). These six patients underwent Caesarean section. Vaginal delivery was recommended in all others. There were two procedure-related complications. There were no cases of intraventricular haemorrhage in any of the neonates. In conclusion, there is a high incidence of fetal thrombocytopenia in women with ITP. PUBS reliably detects fetal thrombocytopenia and is therefore useful in the perinatal planning of the mode and site of delivery.

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“…We found a low incidence of fetal thrombocytopenia and no significant correlation between maternal and fetal thrombocytopenia. Moreover, the reported dispar ity between the maternal and fetal platelet counts and the presence or absence of neonatal bleeding were con firmed in our study [17,18], We attribute the disparity partly to technical errors resulting from the adherence of fetal blood to the pipette wall, but mainly to the fact that fetal and maternal physiological mechanisms, though similar, are not identical (most probably elimination mechanisms). Clearly, no conclusion about the fetal thrombocyte count can be drawn on the basis of the maternal thrombocyte count alone, especially when such conclusions will at least dictate the mode of delivery.…”

Section: Discussionmentioning

confidence: 67%

Management of Labor in Patients with Idiopathic Thrombocytopenic Purpura

Dan

Barkai

David

et al. 1989

Gynecol Obstet Invest

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Transient thrombocytopenia may occur in infants born to mothers with idiopathic thrombocytopenic purpura, suggesting transplacental passage of the antiplatelet factor. Labor in women with idiopathic thrombocytopenic purpura calls for a special management. Irrespective of the maternal platelet count, we believe that labor should be conducted vaginally but reassessed after a thrombocyte count of fetal scalp blood. Maternal thrombocytopenia, which may indicate a possible risk of coagulopathy, should be treated aggressively and followed up with replacement therapy. Percutaneous umbilical sampling is to be avoided because it carries an immediate risk of fetal and maternal complications. A count of 50,000/mm³, obtained early during the course of labor, may be taken as a threshold indicator for abdominal delivery via cesarean section.

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Pregnancy in patients with autoimmune thrombocytopenic purpura

Cited by 32 publications

References 13 publications

Relationships between severe neonatal thrombocytopenia and maternal characteristics in pregnancies associated with autoimmune thrombocytopenia

Relationships between severe neonatal thrombocytopenia and maternal characteristics in pregnancies associated with autoimmune thrombocytopenia

The Role of Percutaneous Umbilical Blood Sampling in the Management of Immune Thrombocytopenic Purpura

Management of Labor in Patients with Idiopathic Thrombocytopenic Purpura

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