A proposal for the proper management of thrombocytopenia in pregnancy based on 10 years of experience

Chung, Jae Eun; Park, Yong Won; Coe, Yoon Woong; Kim, Jae Wook

Abstract

OBJECTIVE
To evaluate the pregnancy outcome, designate the predicting factor of neonatal thrombocytopenia, and reevaluate the treatment scheme of idiopathic thrombocytopenic purpura (ITP) in pregnancy.
METHODS
Medical records of 83 patients(98 deliveries) who were diagnosed as having ITP and delivered at the Department of Obstetrics and Gynecology, Yonsei University College of Medicine from January 1990 to May 1999 were reviewed. For statistical analysis Chi-square test and Fisher's exact test were used.
RESULTS
Among various maternal characteristics, inability to raise platelet counts more than 100,000/mm3 by any means of treatment, categorized as ""poor response to treatment"", could be designated as the predicting factor of neonatal thrombocytopenia (p<0.05). Pregnant women treated with prednisolone had significantly greater chance of having preterm delivery (p<0.001). The occurrence of postpartum anemia requiring transfusion was higher in the group undertaking cesarean section (p<0.05). Although a control group was missing, the pregnancy outcome was poor in the category of pregnancy induced hypertension(PIH) and preterm labor being 17.3% and 33.7%, respectively.
CONCLUSION
The ITP patient should be carefully monitored during the antenatal care visits because of the increased incidence in adverse pregnancy outcome such as PIH and preterm labor. Neonatal thrombocytopenia could be predicted in the presence of inability to raise platelet counts to more than 100,000/mm3 by any means of treatment. Cesarean section should not be performed routinely under the indication of ITP due to the accompanynig morbidity and low incidence of bleeding sequalae in the neonate. The accompanying complications of prednisolone treatment raises questions and warnings about its usage, therefore a prospective study is warranted to evaluate the effect and complications of prednisolone treatment.