Outcome of Pregnancy in Women with Idiopathic Thrombocytopenic Purpura

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Abstract
EDITORIAL COMMENT: We accepted this paper for publication because it provides useful information concerning idiopathic thrombocytopenic purpura (ITP) in a centre in which cordocentesis and fetal scalp-blood sampling for antepartum assessment of fetal blood platelet counts is not performed. The results in this series of 28 pregnancies were excellent in that the only fetal loss was an intrauterine death at 32 weeks' gestation; it is difficult to see how antepartum testing could have prevented this death even if it was due to ITP. The series includes a mother who may have lost 3 previous infants from intracranial haemorrhage due to ITP. This woman was thereafter delivered in 2 pregnancies by Caesarean section, with both infants surviving, their cord blood platelet counts being shown in the footnote to table 2 provided by the authors after reading the original editorial comment. The authors do not favour Caesarean section as the preferred method of delivery in women with ITP, because of the fetal risk of intracranial haemorrhage, unless the maternal blood platelet count is 9/L. However in this series the mothers of 3 of the 4 infants born with cord blood platelet counts 9/ had platelet counts at delivery 9/L and 2 had platelet counts 9/L. The authors also remind us that women with ITP require special management for safe Caesarean section. Summary: The obstetric management and haematological problems in 28 pregnancies of 23 mothers with idiopathic thrombocytopenic purpura (ITP) are analyzed. There was no maternal death and only 1 stillbirth occurred in the series. Ten infants were born by Caesarean section and 18 were delivered vaginally. Neonatal cord blood platelet counts showed thrombocytopenia in 12 infants, but in only 4 (14.3%) was the cord blood platelet count 9/L. None of the 27 liveborn infants died, although 4 required supportive treatment with corticosteroids and IgG. No maternal characteristics could be used to predict the neonatal platelet count. These results are comparable with other studies reported in the literature. The rarity of poor neonatal outcome in mothers with ITP does not justify obstetric intervention solely on the basis of their platelet counts. The management of patients should be individualized and carefully planned.

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