THROMBOCYTOPENIA IN PREGNANT-WOMEN INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS - MATERNAL AND NEONATAL OUTCOME

OBJECTIVES: Our purpose was to evaluate the prevalence of thrombocytop enia related to human immunodeficiency virus among seropositive pregna nt women and its impact on maternal and neonatal outcome. STUDY DESIGN : A retrospective survey of all deliveries of women infected with huma n immunodeficiency virus in 14 maternity units in France over a 6-year period collected data on mothers who had thrombocytopenia <100.10(9)/ L and their infants. RESULTS: Among 890 women, 29 were thrombocytopeni c (3.2%, 95% confidence interval 2.1% to 4.3%). Thrombocytopenia appea red directly related to human immunodeficiency virus infection in 25 o f these women. During pregnancy 16 patients were treated for thrombocy topenia with zidovudine, corticosteroids, or high-dose intravenous gam ma globulin. Zidovudine was effective in five of seven cases, and intr avenous gamma globulin was effective in five of 11 cases. Cesarean sec tions were performed in 13 of 29 women. Abnormal intrapartum or postpa rtum bleeding was recorded in five cases. Among 28 infants for whom ne onatal platelet counts were available, only one had thrombocytopenia < 100.10(9)/L at birth; he went on to have early-onset acquired immunode ficiency syndrome. CONCLUSIONS: The incidence of fetal or neonatal thr ombocytopenia appears low and may not justify invasive sampling or rou tine cesarean delivery. Therapy with zidovudine or intravenous gamma g lobulin should be considered for women with severe thrombocytopenia, b ecause of the risk of maternal hemorrhage.