IDIOPATHIC THROMBOCYTOPENIC PURPURA IN PREGNANCY

Objective. The aim of this study was to evaluate retrospectively our s trategies in monitoring and treating pregnant women with idiopathic th rombocytopenic purpura (ITP). Methods. Medical records were reviewed f or diagnosis, clinical course, treatment, and neonatal outcome in 35 F innish women with ITP giving birth to 55 neonates during 53 pregnancie s. The outcome of the first (i.e. index) pregnancy was used in the sta tistical analyses. The platelet immunofluorescence test (PIFT) was use d for detection of platelet autoantibodies. The correlation between ne onatal platelet counts and results of PIFT was calculated with the Pea rson's correlation coefficient and the Fisher's exact test. Results. T here were no serious bleeding complications although five of 35 women had platelet counts of less than 50x10(9)/l in the third trimester of the index pregnancy. Prophylactic platelet transfusions were given to six of lj women delivered by cesarean section. Five of 35 (14.3%; 95% confidence interval, 2.6 to 25.8%) neonates had platelet counts of les s than 50x10(9)/l median 3 days after delivery versus only one of 28 ( 3.6%; 95% confidence interval, 0.1 to 10.5%) at birth. No infant showe d any clinical signs of intracranial hemorrhage. No significant correl ation was encountered between neonatal thrombocytopenia and maternal p latelet autoantibodies. The history of a previous infant with thromboc ytopenia was the only important information in estimating the risk of fetal thrombocytopenia. Conclusions. To avoid unnecessary and possibly harmful monitoring and treatment, we need further tests for predictin g the perinatal risks in pregnant women with ITP.