Maternal characteristics and risk of severe neonatal thrombocytopenia and intracranial hemorrhage in pregnancies complicated by autoimmune thrombocytopenia.
OBJECTIVE
The antenatal and intrapartum management of women with autoimmune thrombocytopenia is controversial. The current approach emphasizes an effort to identify maternal characteristics predictive of severe neonatal thrombocytopenia or to measure fetal platelet counts and perform cesarean section in patients considered to be at risk for neonatal intracranial hemorrhage. In the current study we review our experience with maternal autoimmune thrombocytopenia and neonatal outcome.


METHODS
Fifty-five pregnancies with autoimmune thrombocytopenia over a 10-year period in three major medical centers in San Diego, California, were evaluated. Maternal characteristics and neonatal outcomes were assessed and compared with those in other recent reports. Data were submitted to Fisher's exact (two-tailed), chi2, and Student t tests, with linear regression performed to analyze the association between variables.


RESULTS
Maternal characteristics including platelet count, presence of antiplatelet antibody, antecedent history of autoimmune thrombocytopenia, and corticosteroid therapy were not predictive of severe neonatal thrombocytopenia. Maternal history of splenectomy was significantly 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 neonates with severe neonatal thrombocytopenia (8%), and one who was delivered by cesarean section had intracranial hemorrhage.


CONCLUSIONS
These findings, combined with others in the literature, confirm that severe 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 for obstetric indications only.
Payne
S D
SD
Department of Reproductive Medicine, University of California, San Diego Medical Center, La Jolla 92093-0621, USA.
Resnik
R
R
Moore
T R
TR
Hedriana
H L
HL
Kelly
T F
TF
D000293:Adolescent; D000328:Adult; D001327:Autoimmune Diseases / Q000150:complications* / Q000453:epidemiology* / Q000209:etiology; D002140:California / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005312:Fetal Blood / Q000166:cytology; D006801:Humans; D007231:Infant, Newborn; D016014:Linear Models; D008137:Longitudinal Studies; D008429:Maternal Welfare; D010976:Platelet Count; D011237:Predictive Value of Tests; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000453:epidemiology*; D011256:Pregnancy Outcome; D012307:Risk Factors; D012720:Severity of Illness Index; D013156:Splenectomy; D013921:Thrombocytopenia / Q000150:complications* / Q000453:epidemiology* / Q000209:etiology