Sh. Garmel et al., THE ROLE OF PERCUTANEOUS UMBILICAL BLOOD-SAMPLING IN THE MANAGEMENT OF IMMUNE THROMBOCYTOPENIC PURPURA, Prenatal diagnosis, 15(5), 1995, pp. 439-445
On consultation, percutaneous umbilical blood sampling (PUBS) was offe
red to women with immune thrombocytopenic purpura (ITP) to determine t
he mode and site of delivery prior to labour. Between January 1989 and
December 1993, 41 pregnant women underwent PUBS. Ah women had a histo
ry of ITP, a platelet count less than 90 K, (+) antiplatelet antibody,
and/or thrombocytopenia diagnosed early in pregnancy. PUBS was perfor
med at term except in one patient with preterm labour, who underwent P
UBS at 31 weeks' gestation. Patients with fetal platelet counts greate
r than 50 K returned to their referring physician for delivery. Record
s were complete in 39 pregnancies. Fetal blood was successfully obtain
ed in 37 of 39 cases (95 per cent). Fetal platelet counts correlated w
ith neonatal platelet counts in 36 of 37 cases (97 per cent). The inte
rval between PUBS and delivery ranged from 0 to 31 days. Six of 37 fet
uses (16 per cent) had significant fetal thrombocytopenia (<50 K). The
se six patients underwent Caesarean section. Vaginal delivery was reco
mmended in all others. There were two procedure-related complications.
There were no cases of intraventricular haemorrhage in any of the neo
nates. In conclusion, there is a high incidence of fetal thrombocytope
nia in women with ITP. PUBS reliably detects fetal thrombocytopenia an
d is therefore useful in the perinatal planning of the mode and site o
f delivery.