Fireogfyrre svangerskaber med idiopatisk trombocytopenisk purpura

INTRODUCTION: The aim of this project was to describe the course of pregnancy with idiopathic thrombocytopenic purpura (ITP) and to estimate risk factors and indications for treatment.

MATERIAL AND METHODS: Birth, haematological, and neonatal files were examined retrospectively.

RESULTS: Forty-eight ITP women with 55 pregnancies gave birth to 61 children, 59 live-born. The first singleton pregnancy in the observation period (the index pregnancy) was used for statistics, namely 44 index pregnancies. A maternal platelet fall from the first trimester to delivery was seen, as was a platelet rise three days after delivery (p < 0.0001), even in splenectomised women. Thirty-six per cent of the women had bleeding manifestations, none of which were fatal; 33% of the newborn infants had thrombocytopenia in cord blood. The following risk factors for perinatal thrombocytopenia were found: a sibling with thrombocytopenia, severe maternal thrombocytopenia, male gender. The nadir platelet count in the newborn infants was seen up to seven days after delivery. The presence of an older sibling with neonatal ITP is a risk factor for neonatal ITP in subsequent pregnancies. A significant association was found between the maternal platelet count in the second trimester and the platelet count in cord blood.

DISCUSSION: The diagnosis and treatment of ITP in pregnancy are controversial. Vaginal delivery is generally recommended. The platelet kinetics in pregnancy with ITP is comparable with the platelet kinetics of the spleen.