Congenital thrombotic thrombocytopenic purpura (TTP) with placental abruption despite maternal improvement: a case report

Marti D Soffer,Jeffrey L Ecker,Ilona T Goldfarb,Allison Bryant,Drucilla J Roberts,Pavan K Bendapudi,P Kaitlyn Edelson,David J Kuter

doi:10.1186/s12884-020-03051-2

Marti D Soffer, Jeffrey L Ecker + Show 6 more

Open Access

https://doi.org/10.1186/s12884-020-03051-2

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Journal: BMC Pregnancy and Childbirth	Publication Date: Jun 15, 2020
Citations: 2	License type: open-access

Affiliation: Massachusetts General Hospital

Abstract

BackgroundThrombotic thrombocytopenic purpura (TTP) is a rare but serious complication in pregnancy that places the mother and fetus at high risk for morbidity and mortality. This case illustrates novel pregnancy complications associated with this rare medical condition.Case presentationA 31-year-old G3P0020 at 28 weeks and 1 day was admitted with severe thrombocytopenia and was ultimately diagnosed with TTP. With therapeutic plasma exchange (TPE), maternal status improved. At 28 weeks 6 days, however, non-reassuring fetal testing prompted cesarean delivery with placental abruption noted intraoperatively. Pathology examination confirmed placental abruption and also revealed multiple placental infarcts.ConclusionWhile medical management of TTP can significantly improve the health of the mother, this case highlights the potential role of TTP in abruption and other placental pathology and thus, the need for close fetal surveillance throughout an affected pregnancy.

Highlights

Thrombotic thrombocytopenic purpura (TTP) is a rare but serious complication in pregnancy that places the mother and fetus at high risk for morbidity and mortality
While medical management of TTP can significantly improve the health of the mother, this case highlights the potential role of TTP in abruption and other placental pathology and the need for close fetal surveillance throughout an affected pregnancy
Thrombotic thrombocytopenic purpura (TTP) is a rare hematologic condition that leads to severe thrombocytopenia and occlusive microangiopathywith potential sequalae including neurological abnormalities

Summary

Conclusion

While medical management of TTP can significantly improve the health of the mother, this case highlights the potential role of TTP in abruption and other placental pathology and the need for close fetal surveillance throughout an affected pregnancy.

Background

Findings

Discussion and conclusions