OUTCOME ANALYSIS OF 34 PREGNANCIES IN WOMEN WITH ESSENTIAL THROMBOCYTHEMIA

Objective: To evaluate the clinical impact of essential thrombocythemi a on the outcome of pregnancy or vice versa. Design: A retrospective s tudy. Setting: All patients were seen at our tertiary referral center, and most were followed up by their local physicians. Patients: From 1 975 through 1991, 73 women younger than 50 years with essential thromb ocythemia were seen at our institution. All patients were followed up through patient or physician contact. A detailed obstetric history, in cluding peripartum complications and management, was obtained. Results : Among the 73 women, 34 pregnancies occurred in 18 patients. There we re two uncomplicated elective abortions and one ectopic pregnancy. Of the 31 other pregnancies, 17 (55%) resulted in live birth and 14 (45%) ended in spontaneous abortion (all but two in the first trimester). A bortion could not be predicted from history of disease complications b efore or during pregnancy or by the presence or absence of specific th erapy during pregnancy. Preconception platelet counts in women whose p regnancies resulted in live birth were similar to those of women whose pregnancies ended in abortion. Other complications during pregnancy w ere rare. Conclusions: Patients with essential thrombocythemia have an increased risk of first-trimester abortion, which does not appear to be predictable or influenced by therapy. However, most patients are ab le to carry pregnancies to term with little or no risk of obstetric or thrombohemorrhagic complications during or after delivery. Overall, s pecific therapy during pregnancy did not appear to modify the clinical outcome, and the benefit of platelet apheresis during delivery could not be substantiated.