Maternal and neonatal outcomes in pregnant women with immune thrombocytopenic purpura

Abstract

Introduction Idiopathic thrombocytopenic purpura commonly affects women of childbearing age. Pregnancy with immune thrombocytopenic purpura (ITP) may be associated with maternal and fetal complications. Pregnant patients with ITP need close antenatal monitoring. The combined care of the obstetrician, the hematologist and the neonatologist usually will improve the pregnancy outcome. Aim To study the maternal and fetal outcome in pregnancies with ITP. Patients and methods A retrospective prospective study over the 4-year period, from April 2009 to May 2013, in which maternal and neonatal data of 25 pregnant women with ITP admitted in the High-Risk Pregnancy Unit, Department of Obstetrics and Gynecology, Kasr Al Aini Hospital, were reviewed. Results Of the 25 pregnant patients with ITP, 11 (44%) women were already diagnosed as ITP before pregnancy, whereas the other 14 (56%) were diagnosed during pregnancy; 22 (88%) patients had oral steroids during pregnancy, 17 (68%) patients took pulse steroid, whereas three (12%) patients received pulse steroid and immunoglobulin therapy, and two (8%) cases had splenectomy before pregnancy. During the antenatal period, four (16%) patients developed gestational diabetes mellitus, one patient had pre-eclampsia, three (12%) patients showed hemorrhagic manifestation and one of them had placental abruption. There was one patient with intrauterine fetal death and three (12%) had preterm deliveries. There were no cases of abortions or intrauterine growth restriction. At the time of delivery, four (16%) patients had mild thrombocytopenia, 13 (52%) had moderate thrombocytopenia (>50 000/ml) and eight patients (44%) had severe thrombocytopenia with platelet count less than 50 000/ml. There were nine (36%) vaginal deliveries and 16 (64%) cesarean sections. Platelet transfusion was performed in six patients (24%), and two (8%) patients had postpartum hemorrhage. Neonatal thrombocytopenia occurred in four (16.6%) neonates, but no bleeding complications occurred in any of the neonates. Conclusion Pregnant patients with idiopathic thrombocytopenic purpura usually have good maternal and neonatal outcomes. Severe thrombocytopenia and bleeding in the neonates are not common.