Pregnancy in chronic immune thrombocytopenic purpura
Journal Title: International Research Journal of Applied and Basic Sciences - Year 2014, Vol 8, Issue 12
Abstract
Immune thrombocytopenia (ITP) is an acquired immune-mediated disorder characterized by isolated thrombocytopenia in the absence of any obvious underlying cause. We evaluated the outcomes of pregnancies complicated with preexisting chronic ITP.A reviewed was performed on 21 women with chronic ITP in Imam Khomeini Hospital of Urmia University of Medical Sciences, from Jan 2009 to Jan 2013. Information collected for infants included platelet count at birth, complications at birth, and treatments received .Two patients with refractory ITP have been splenectomized 6 and 11 years before pregnancy. Both these splenectomized patients were persistently thrombocytopenic after splenectomy. Seventeen patients with chronic ITP, after fail of steroid, were treated or observed without splenectomy. Five (22%) of pregnancies were unsuccessful and have early termination, four in first and one in third trimester (7th month). Both splenectomized patients complicated by abortion in first trimester. Symptoms of hemostatic impairment were noted in seven (35%), six developed petechiae, purpura and easy bruising and one recurrent minimal gum bleedings. Eighteen (78%) full term live birth deliveries occurred in 23 pregnancies of 19 ITP patients. The delivery was vaginal in 14 (78%) and caesarean section in four (22%) cases. No bleeding complications occurred in any of the neonates.It is in good accordance with general acceptance that babies born to mothers with ITP may be delivered vaginally unless a cesarean section is indicated for obstetric reasons.In conclusion, the results of this study regarding pregnancies in women with ITP confirm the low risk of hemorrhage in infants and mothers, and support the conservative approach in their management. Also our findings suggest that splenectomy in ITP, particularly if not improves thrombocytopenia, may have worse impact on fetus.
Authors and Affiliations
Davood Maleki| Hematology & Oncology Ward, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, West Azerbaijan, Iran., Fatemeh Bahadori| Perinatologist, Associate professor, Obstetrics & Gynecology department, Motahhari Hospital, Urmia University of Medical Sciences, Urmia, West Azerbaijan, Iran, email: bahadori1976@gmail.com
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