Perinatal management of women with immune thrombocytopenic purpura: Surveyof United States perinatologists

OBJECTIVE: The aim of the study was to determine how perinatologists in the United States manage the care of women with immune thrombocytopenic purpur a with respect to mode of delivery. STUDY DESIGN: US members of the Society of Perinatal Obstetricians were sur veyed with a 4-question questionnaire. Two mailings were sent. Questions 1 and 2 asked for a response regarding the perinatal management of delivery f or women with chronic immune thrombocytopenic purpura and new-onset disease . The options were cordocentesis or fetal scalp blood sampling and cesarean delivery if the platelet count was <50,000 cells/mu L, cesarean delivery i f the maternal platelet count was <50,000 cells/mu L, cesarean delivery of all women with immune thrombocytopenic purpura, and trial of labor without determining fetal platelet count. The third question asked for an opinion o n whether cesarean delivery was protective against intracranial hemorrhage in cases of immune thrombocytopenic purpura. The fourth question asked whet her the practitioner was in academic or private practice or both. RESULTS: Among the 1596 perinatologists surveyed, there were 940 informativ e responses (58.9%). Most would allow a trial of labor for women with chron ic (59.0%) or new-onset (66.6%) immune thrombocytopenic purpura. in cases o f chronic immune thrombocytopenic purpura, 31.0% of those responding would perform an invasive procedure to determine fetal platelet count, followed b y cesarean delivery if this count was <50,000 cells/mu L. In cases of new-o nset immune thrombocytopenic purpura, 25.4% would do so. Of the respondents , 11.8% reportedly considered cesarean delivery protective against intracra nial hemorrhage, whereas 56.6% did not and 31.6% were unsure. CONCLUSIONS: The management of women with immune thrombocytopenic purpura r emains controversial in the United States. Approximately two thirds of peri natologists would allow a trial of labor without a procedure to determine f etal platelet count. Most physicians surveyed did not consider cesarean del ivery to be protective against intracranial hemorrhage.