Management of essential thrombocythaemia during pregnancy

Essential thrombocythaemia is a rare myeloproliferative disorder that often presents with haemorrhagic or thrombotic complications. It may be detected incidentally in an asymptomatic younger adult and there are only a few cas e reports of essential thrombocythaemia in pregnant women. The risks posed by essential thrombocythaemia during pregnancy and its optimal management a re uncertain. To determine if there is increased incidence of obstetric com plications seen in women who have essential thrombocythaemia, we collected a large case series from a number of tertiary obstetric units in Australia and New Zealand. There were 30 pregnancies in 12 women who had essential thrombocythaemia. T here were 17 live births (57%), 7 stillbirths (23%), 5 miscarriages (17%) a nd 1 ectopic (3%). Five pregnancies were complicated by placental abruption . When the outcomes of those women who received treatment with aspirin or i nterferon were compared to those that did not receive any treatment, there was a trend towards a higher livebirth rate (79% v 38%, p = 0.06). Seven wo men were treated with aspirin and 5 had successful outcomes with no fetal c omplications. Four women were treated with alpha-interferon which reduced t heir platelet counts and all had successful outcomes with no fetal. complic ation. These findings suggest that there is a high incidence of miscarriage , stillbirth and abruption in women with essential thrombocythaemia. Their pregnancies should be carefully monitored. Treatment with low dose aspirin and/or the use of alpha-interferon may be associated with an improved pregn ancy outcome.