MATERNAL CHARACTERISTICS AND RISK OF SEVERE NEONATAL THROMBOCYTOPENIAAND INTRACRANIAL HEMORRHAGE IN PREGNANCIES COMPLICATED BY AUTOIMMUNE THROMBOCYTOPENIA

OBJECTIVE: The antenatal and intrapartum management of women with auto immune thrombocytopenia is controversial. The current approach emphasi zes an effort to identify maternal characteristics predictive of sever e neonatal thrombocytopenia or to measure fetal platelet counts and pe rform cesarean section in patients considered to be at risk for neonat al intracranial hemorrhage. In the current study we review our experie nce with maternal autoimmune thrombocytopenia and neonatal outcome. ST UDY DESIGN: Fifty-five pregnancies with autoimmune thrombocytopenia ov er a 10-year period in three major medical centers in San Diego, Calif ornia, were evaluated. Maternal characteristics and neonatal outcomes were assessed and compared with those in other recent reports. Data we re submitted to Fisher's exact (two-tailed), chi(2), and Student t tes ts, with linear regression performed to analyze the association betwee n variables. RESULTS: Maternal characteristics including platelet coun t, presence of antiplatelet antibody, antecedent history of autoimmune thrombocytopenia, and corticosteroid therapy were not predictive of s evere neonatal thrombocytopenia. Maternal history of splenectomy was s ignificantly correlated with fetal platelet counts <50 x 10(9)/L(odds ratio 5.63; 95% confidence interval 2.2 to 14.3). There were four neon ates with severe neonatal thrombocytopenia (8%), and one who was deliv ered by cesarean section had intracranial hemorrhage. CONCLUSIONS: The se findings, combined with others in the literature, confirm that seve re neonatal thrombocytopenia is an infrequent complication of maternal autoimmune thrombocytopenia and is not reliably predicted by maternal characteristics. Intracranial hemorrhage is also a rare event and is not related to mode of delivery. Cesarean section should be reserved f or obstetric indications only.