Abstract
Aim: To evaluate clinical characteristics, maternal and neonatal outcomes among pregnant women with primary autoimmune thrombocytopenia (ITP).
Materials and methods: All pregnant women with ITP who had undergone antenatal follow-up and delivery at the Department of Obstetrics and Gynecology at a referral center, between 2011 and 2021, were retrospectively investigated. Patients were evaluated in three groups according to antenatal
treatment modality.
Results: 42 pregnant women with ITP were included in the study. A total of 29 (%69) pregnant womenhad been diagnosed with ITP before pregnancy and 13(%31) were diagnosed during pregnancy. 17 (%41) pregnant women did not receive any antenatal treatment, and 25 (%59) pregnant women receieved treatment. Postpartum haemorrhage (%50) was reported more frequently in the
steroids+IVIG group. A total of 42 pregnancies, 43 babies (one twin pregnancy, 41 singletons) were liveborn. Three neonates (%7) had thrombocytopenia and one of them had intracranial haemorrhage.
Conclusions: In pregnancies complicated with ITP, the platelet count is moderately or severely low, which can have adverse maternal and neonatal outcomes. Postpartum haemorrhage is a significant cause of maternal morbidity in cases with ITP. Therefore, pregnant women with ITP should be delivered in facilities that can adequately manage postpartum haemorrhage.
Keywords
primary autoimmune thrombocytopenia neonatal thrombocytopenia pregnancy antenatal treatment
References
- Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009 Mar 12; 113 (11): 2386-93.
- Care A, Pavord S, Knight M, Alfirevic Z. Severe primary autoimmune thrombocytopenia in pregnancy: a national cohort study. BJOG 2018; 125: 604-12.
- Terrell DR, Beebe LA, Vesely SK, Neas BR, Segal JB, George JN. The incidence of immune thrombocytopenic purpura in children and adults: A critical review of published reports. Am J Hematol. 2010; 85 (3): 174-80.
- Stavrou E, McCrae KR. Immune thrombocytopenia in pregnancy. Hematol Oncol Clin North AM. 2009; 23: 1299-316.
- McCrae KR. Thrombocytopenia in pregnancy. Hematology Am Soc Hematol Educ Program; 2010: 397-402.
- Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood, 2010; 115:168-86.
- Burrows RF, Kelton JG. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. N Engl J Med 1993; 329: 1463-6.
- WHO. WHO recommendations for the prevention and treatment of postpartum haemorrhage Geneva: Dept. of Reproductive Health and Research, WHO, 2012. ISBN: 978 92 4 154850 2.
- Boehlen F, Hohlfeld P, Extermann P, Perneger TV, de Moerloose P. Platelet count at term pregnancy: a reappraisal of the threshold. Obstet Gynecol. 2000; 95 (1): 29-33.
- Gernsheimer T, James AH, Stasi R.HowItreatthrombocytopenia in pregnancy. Blood. 2012; 121: 38–47.
- Ozkan H, Cetinkaya M, Köksal N, Ali R, Güneş AM, Baytan B, Ozkalemkaş F, Ozkocaman V, Ozçelik T, Günay U, Tunali A, Kimya Y, Cengiz C. Neonatal outcomes of pregnancy complicated by idiopathic thrombocytopenic purpura. J Perinatol. 2010; 30: 38-44.
- Mundkur, Anjali, KP Murali Krishnan Nambiar, Lavanya Rai. "Low platelet counts in pregnancy: an alarm signal for abruption!." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7.3 (2018): 1191-96.
- Webert KE, Mittal R, Sigouin C, Heddle NM, Kelton JG. A retrospective 11-year analysis of obstetric patients with idiopathic thrombocytopenic purpura. Blood. 2003 15;4306-11.
- ACOG Practice Bulletin No. 207: thrombocytopenia in preg- nancy. Obstet Gynecol. 2019; 133: e181–e193.
- Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, Tinmouth AT, Capocelli KE, et al. Platelet transfusion: a clinical practice guideline from the AABB. Ann Intern Med. 2015 Feb 3; 162 (3): 205-13.
- Wyszynski DF, Carman WJ, Cantor AB, Graham JM Jr, Kunz LH, Slavotinek AM, et al. Pregnancy and Birth Outcomes among Women with Idiopathic Thrombocytopenic Purpura. J Pregnancy. 2016; 2016: 8297407.
- Loustau V, Debouverie O, Canoui-Poitrine F, Baili L, Khellaf M, Touboul C, et al. Effect of pregnancy on the course of immune thrombocytopenia: a retrospective study of 118 pregnancies in 82 women. Br J Haematol. 2014; 166: 929-35.
- Van Veen JJ, Nokes TJ, Makris M. The risk of spinal hematoma following neuraxial anesthesia or lumbar puncture in thrombocytopenic individuals. Br J Haematol. 2010; 148: 15–25.
- Fogerty AE. Thrombocytopenia in pregnancy: mechanisms and management. Transfus Med Rev. 2018; 32:225–9.
- Kaplan, C., Daffos, F., Forestier, F., Tertian, G., Catherine, N., Pons, J. C., et al. Fetal platelet counts in thrombocytopenic pregnancy. Lancet, 1990; 336: 979–82.
- Ferreira IJMCF, Sousa F, Vasco EM, Areia ALFA, Moura JPAS, Carda J, Ribeiro L. Severe immune thrombocytopenia in pregnancy treated with Eltrombopag - A case report. J Gynecol Obstet Hum Reprod. 2018 Oct; 47 (8): 405-8.
Abstract
Amaç: Primer otoimmün trombositopenili (ITP) gebelerde klinik özellikler, maternal ve yenidoğan sonuçlarını değerlendirmek.
Gereç ve Yöntem: 2011 ve 2021 yılları arasında referans bir merkezde, Kadın Hastalıkları ve Doğum Bölümünde antenatal takip ve doğumları gerçekleştirilen tüm ITP’ li gebe kadınlar retrospektif olarak
incelendi. Hastalar antenatal tedavi modalitelerine göre üç grupta değerlendirildi.
Bulgular: Çalışmaya ITP’ li 42 gebe kadın dahil edildi. Gebe kadınların 29’ u (%69) gebelik öncesi, 13’ ü (%31) gebelik sırasında ITP tanısı aldı. Gebe kadınların 17’ si (%41) antenatal dönemde tedavi
almaz iken, 25’ i (%59) antenatal tedavi aldı. Postpartum hemoraji steroid+İVİG grubunda daha sık görüldü (%50). 42 gebelikten 43 (bir ikiz gebelik, 41 tekil gebelik) canlı doğum gerçekleşdi. Üç yenidoğanda (%7) trombositopeni görülürken, bunlardan birinde intrakranial kanama izlendi.
Sonuç: ITP ile komplike gebeliklerde platelet sayısı orta veya ciddi derecede düşüktür, olumsuz maternal ve neonatal sonuçlara neden olabilir. İTP’ li olgularda postpartum hemoraji önemli bir
maternal morbidite nedenidir. Bu nedenle İTP ‘li gebeler, postpartum hemorajiyi etkin bir şekilde yöneten merkezlerde doğurtulmalıdır.
References
- Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009 Mar 12; 113 (11): 2386-93.
- Care A, Pavord S, Knight M, Alfirevic Z. Severe primary autoimmune thrombocytopenia in pregnancy: a national cohort study. BJOG 2018; 125: 604-12.
- Terrell DR, Beebe LA, Vesely SK, Neas BR, Segal JB, George JN. The incidence of immune thrombocytopenic purpura in children and adults: A critical review of published reports. Am J Hematol. 2010; 85 (3): 174-80.
- Stavrou E, McCrae KR. Immune thrombocytopenia in pregnancy. Hematol Oncol Clin North AM. 2009; 23: 1299-316.
- McCrae KR. Thrombocytopenia in pregnancy. Hematology Am Soc Hematol Educ Program; 2010: 397-402.
- Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood, 2010; 115:168-86.
- Burrows RF, Kelton JG. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. N Engl J Med 1993; 329: 1463-6.
- WHO. WHO recommendations for the prevention and treatment of postpartum haemorrhage Geneva: Dept. of Reproductive Health and Research, WHO, 2012. ISBN: 978 92 4 154850 2.
- Boehlen F, Hohlfeld P, Extermann P, Perneger TV, de Moerloose P. Platelet count at term pregnancy: a reappraisal of the threshold. Obstet Gynecol. 2000; 95 (1): 29-33.
- Gernsheimer T, James AH, Stasi R.HowItreatthrombocytopenia in pregnancy. Blood. 2012; 121: 38–47.
- Ozkan H, Cetinkaya M, Köksal N, Ali R, Güneş AM, Baytan B, Ozkalemkaş F, Ozkocaman V, Ozçelik T, Günay U, Tunali A, Kimya Y, Cengiz C. Neonatal outcomes of pregnancy complicated by idiopathic thrombocytopenic purpura. J Perinatol. 2010; 30: 38-44.
- Mundkur, Anjali, KP Murali Krishnan Nambiar, Lavanya Rai. "Low platelet counts in pregnancy: an alarm signal for abruption!." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7.3 (2018): 1191-96.
- Webert KE, Mittal R, Sigouin C, Heddle NM, Kelton JG. A retrospective 11-year analysis of obstetric patients with idiopathic thrombocytopenic purpura. Blood. 2003 15;4306-11.
- ACOG Practice Bulletin No. 207: thrombocytopenia in preg- nancy. Obstet Gynecol. 2019; 133: e181–e193.
- Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, Tinmouth AT, Capocelli KE, et al. Platelet transfusion: a clinical practice guideline from the AABB. Ann Intern Med. 2015 Feb 3; 162 (3): 205-13.
- Wyszynski DF, Carman WJ, Cantor AB, Graham JM Jr, Kunz LH, Slavotinek AM, et al. Pregnancy and Birth Outcomes among Women with Idiopathic Thrombocytopenic Purpura. J Pregnancy. 2016; 2016: 8297407.
- Loustau V, Debouverie O, Canoui-Poitrine F, Baili L, Khellaf M, Touboul C, et al. Effect of pregnancy on the course of immune thrombocytopenia: a retrospective study of 118 pregnancies in 82 women. Br J Haematol. 2014; 166: 929-35.
- Van Veen JJ, Nokes TJ, Makris M. The risk of spinal hematoma following neuraxial anesthesia or lumbar puncture in thrombocytopenic individuals. Br J Haematol. 2010; 148: 15–25.
- Fogerty AE. Thrombocytopenia in pregnancy: mechanisms and management. Transfus Med Rev. 2018; 32:225–9.
- Kaplan, C., Daffos, F., Forestier, F., Tertian, G., Catherine, N., Pons, J. C., et al. Fetal platelet counts in thrombocytopenic pregnancy. Lancet, 1990; 336: 979–82.
- Ferreira IJMCF, Sousa F, Vasco EM, Areia ALFA, Moura JPAS, Carda J, Ribeiro L. Severe immune thrombocytopenia in pregnancy treated with Eltrombopag - A case report. J Gynecol Obstet Hum Reprod. 2018 Oct; 47 (8): 405-8.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | March 15, 2023 |
| Submission Date | June 26, 2022 |
| Published in Issue | Year 2023 |