DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20204806

Pregnancy outcomes of mothers with immune thrombocytopenia

Shashikala Karanth, Christy Vijay, Chaitanya Harita, Jaya S. Mol

Abstract


Background: It has been proposed that, thrombocytopenia is the most common haematological abnormality in pregnancy after anaemia. The incidence of severe immune thrombocytopenia (ITP) in pregnancy has been difficult to report because of the rarity of the disease. Objectives were to determine the prevalence, pregnancy outcomes, treatment modalities of ITP mothers over five years in a tertiary health care hospital in South India.

Methods: Our study was a retrospective record study, which looked into various aspects of obstetrical outcomes and complications in ITP mothers. Records of the in-patient medical record department (MRD) folders of patients with ITP who delivered at St. Johns Medical Hospital, Bangalore were studied.

Results: We identified 53 patients with ITP with a mean age of 25.6+4.6 years, age of diagnosis of ITP at 21.1+5.9 years and gestational age of 36.2+3 weeks. In our study 17 (32%) were acute and 36 (67.1%) were chronic ITP. In our study 39.6% had history of at least one prior pregnancy loss. Patients with ITP at 35-37 weeks were induced with PGE1 (35.7%) in comparison to those with PGE2 (p≤0.001). Post-partum haemorrage (PPH) was seen in 7.5% of the pregnancies and all four were mothers with chronic ITP. Severe preeclampsia in ITP mothers was seen in 2 (66.7%).

Conclusions: Chronic ITP in pregnancy poses more risks to mother and foetus as seen with the higher chance of PPH etc. Mothers with ITP should be screened antenatally as the chances of anomalies are high in the foetus.

 


Keywords


ITP, APGAR score, Prednesolone, Platelettransfusion, Intrauterine device, Lower segment caesarean section

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References


Gilmore KS, McLintock C. Maternal and fetal outcomes of primary ITP during pregnancy: A retrospective study. Obstet Medic, 2018;11(1):12–6.

Care A, Pavord S, Knight M, Alfirevic Z. Severe primary autoITP in pregnancy: a national cohort study. Int J Obstet Gynaecol. 2018;125(5):604-12.

Melekoğlu NA, Bay A, Aktekin EH, Yilmaz M, Sivasli E. Neonatal outcomes of pregnancy with ITP. Ind J Hematol Bloo Transfus. 2017;33(2):211-5.

Suri V, Aggarwal N, Saxena S, Malhotra P, Varma S. Maternal and perinatal outcome in idiopathic thrombocytopenic purpura (ITP) with pregnancy. Acta obstetricia et gynecolo Scandina. 2006;85(12):1430-5.

Özkan H, Cetinkaya M, Köksal N, Ali R, Güneş AM, Baytan B, et al. Neonatal outcomes of pregnancy complicated by idiopathic thrombocytopenic purpura. J Perinatol. 2010;30(1):38-44.

Yassaee F, Eskandari R, Amiri Z. Pregnancy outcomes in women with idiopathic thrombocytopenic purpura. Irani J Reproduct Medic. 2012;10(5):489–92.

Blanchette S. Glycoproteins in Children Purpura. 2012;5(5):1600–2.

Algadiem EA, Ali Algadiem E, Aleisa AA, Alsubaie HI, Buhlaiqah NR, Algadeeb JB, et al. Blood Loss Estimation Using Gauze Visual Analogue. Trauma Mon. 2016;21(2):e34131

Alberto M. Marmont; Antinuclear antibody (ANA)–positive thrombocytopenia: primary, but with a difference. Bloo. 2009;114(9):2003–4.

Perepu U, Rosenstein L. Maternal thrombocytopenia in pregnancy. Proc Obstet Gynecol. 2013;10;3(1):15.

Gernsheimer T, James AH, Stasi R. How I Treat How I treat thrombocytopenia in pregnancy Establishing the cause of thrombocytopenia. Bloo. 2013;121(1):38–47

Sibai BM. Evaluation and management of severe preeclampsia before 34 weeks’ gestation. Am J Obstet Gynecol. 2011;205(3):191-8.

Ankar A, Kumar A. Vitamin B12 Deficiency (Cobalamin). Available at: https://www.ncbi.nlm. nih.gov/books/NBK441923/. Accessed on 20 May 2020.

Wilson JJ, Neame PB, Kelton JG. Infection-induced thrombocytopenia. Semin Thromb Hemost. 1982;8(3):217-33.

Dellinger RP, Levy MM, Rhodes A. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39:165–228.

Li MF, Li XL, Fan KL. Platelet desialylation is a novel mechanism and a therapeutic target in thrombocytopenia during sepsis: an open-label, multicenter, randomized controlled trial. Journal of Hematology& Oncology. 2017;10(1):104.

Visentin GP, Liu CY. Drug-induced thrombocytopenia. Hematol Oncol Clin North Am. 2013;39:165–228.

Baucom, AM, Kuller JA, Dotters-Katz S. Immune thrombocytopenic purpura in pregnancy. Obstetric Gynecol Surv. 2019;74(8):490–6.

Kalra S, Kalra B, Gupta Y. Glycemic management after antenatal corticosteroid therapy. N Am J Med Sci. 2014;6(2):71-6.

Jaegtvik S, Husebekk A, Aune B, Øian P, Dahl LB, Skogen B. Neonatal alloITP due to anti‐HPA 1a antibodies; the level of maternal antibodies predicts the severity of thrombocytopenia in the newborn. Int J Obstet Gynaecol. 2000;107(5):691-4.

Wyszynski DF, Carman WJ, Cantor AB, Graham JM, Kunz LH, Slavotinek AM, et al. Pregnancy and birth outcomes among women with idiopathic thrombocytopenic purpura. J Pregnan. 2016;2016.

Won YW, Moon W, Yun YS, Oh HS, Choi JH, Lee YY, et al. Clinical aspects of pregnancy and delivery in patients with chronic idiopathic thrombocytopenic purpura (ITP). Kore J Intern Medic. 2005;20(2):129.

De Haan TR, Van Den Akker ES, Porcelijn L, Oepkes D, Kroes AC, Walther FJ. Thrombocytopenia in hydropic fetuses with parvovirus B19 infection: incidence, treatment and correlation with fetal B19 viral load. Int J Obtet Gynaecol. 2008;115(1):76-81.

Comont, T. Re: Severe Primary AutoITP (ITP) in Pregnancy: a national cohort study Primary ITP management during pregnancy. Int J Obstet Gynaecol. 125(5):629–30.

Michel M, Novoa MV, Bussel JB. Intravenous anti‐D as a treatment for immune thrombocytopenic purpura (ITP) during pregnancy. British journal of haematology. 2003;123(1):142-6.

Greave M, Letsky EA. Guidelines on the investigation and management of thrombocytopenia in pregnancy and neonatal alloITP. Int J Obstet Gynaecol, 1997;104(10):1108.

Browning J, James D. ITP in pregnancy’, Fetal and Maternal Medicine Review, 1999;2(2):143–57.

Patil AS. Use of a thrombopoietin mimetic for chronic immune thrombocytopenic purpura in pregnancy. Obstetrics and Gynecology. 2013;122(2) 483–5.