Thrombocytopenia in pregnant women infected with human immunodeficiency virus: maternal and neonatal outcome.
OBJECTIVE
Our purpose was to evaluate the prevalence of thrombocytopenia related to human immunodeficiency virus among seropositive pregnant women and its impact on maternal and neonatal outcome.


METHODS
A retrospective survey of all deliveries of women infected with human immunodeficiency virus in 14 maternity units in France over a 6-year period collected data on mothers who had thrombocytopenia < 100.10(9)/ and their infants.


RESULTS
Among 890 women, 29 were thrombocytopenic (3.2%, 95% confidence interval 2.1% to 4.3%). Thrombocytopenia appeared directly related to human immunodeficiency virus infection in 25 of these women. During pregnancy 16 patients were treated for thrombocytopenia with zidovudine, corticosteroids, or high-dose intravenous gamma globulin. Zidovudine was effective in five of seven cases, and intravenous gamma globulin was effective in five of 11 cases. Cesarean sections were performed in 13 of 29 women. Abnormal intrapartum or postpartum bleeding was recorded in five cases. Among 28 infants for whom neonatal platelet counts were available, only one had thrombocytopenia < 100.10(9)/L at birth; he went on to have early-onset acquired immunodeficiency syndrome.


CONCLUSIONS
The incidence of fetal or neonatal thrombocytopenia appears low and may not justify invasive sampling or routine cesarean delivery. Therapy with zidovudine or intravenous gamma globulin should be considered for women with severe thrombocytopenia, because of the risk of maternal hemorrhage.
Department of Obstetrics-Gynecology, Hôpital Robert Debré, Paris, France.
L
L
Mandelbrot
I
I
Schlienger
A
A
Bongain
A
A
Berrebi
J C
JC
Pons
N
N
Ciraru-Vigneron
J Y
JY
Gillet
J F
JF
Delfraissy
D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000209:etiology* / Q000628:therapy; D011251:Pregnancy Complications, Infectious; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000209:etiology* / Q000628:therapy; D015215:Zidovudine / Q000627:therapeutic use
D016756:Immunoglobulins, Intravenous; D015215:Zidovudine