[Evaluation of gradual conversion to a less invasive therapeutic strategy for pregnant women with alloimmune thrombocytopenia in the fetus for prevention of intracranial hemorrhage].
OBJECTIVE
To evaluate a less invasive management strategy for pregnant women with neonatal alloimmune thrombocytopenia without a history of intracranial haemorrhage.


METHODS
Retrospective and descriptive.


METHODS
In Leiden University Medical Centre, the Netherlands, in the period 1994-August 1999, 31 women with 32 pregnancies were treated. Six women had a history of a sibling with thrombocytopenia and intracranial haemorrhage and 26 a history of a sibling with (severe) thrombocytopenia without haemorrhage. Treatment options consisted of weekly administered intravenous immunoglobulin (ivIG) to the mother without diagnostic cordocentesis, cordocentesis with foetal blood sampling and intrauterine platelet transfusions to the fetus. In the group without history of intracranial haemorrhage fetal blood sampling and platelet transfusion were gradually abandoned as much as possible.


RESULTS
In the children of the treated pregnant women there were no instances of intracranial haemorrhage. In addition, the platelet count in cord blood was higher, compared with patients treated before 1994 and with literature data.


CONCLUSIONS
A less invasive management strategy in case of a history without intracranial haemorrhage seems justified based on results in our population. Administration of ivIG without diagnostic cordocentesis, however, results in a lost opportunity to verify the indication and the effectiveness of treatment.
Radder
C M
CM
Afd. Verloskunde, Leids Universitair Medisch Centrum, Leiden.
Kanhai
H H
HH
de Beaufort
A J
AJ
Klumper
F J
FJ
Brand
A
A
D000075202:Contraindications; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D005331:Fetomaternal Transfusion / Q000276:immunology; D005332:Fetoscopy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000276:immunology / Q000517:prevention & control*; D020300:Intracranial Hemorrhages / Q000276:immunology / Q000517:prevention & control*; D008297:Male; D017713:Platelet Transfusion; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000276:immunology / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods*; D011296:Prenatal Diagnosis / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D013921:Thrombocytopenia / Q000188:drug therapy* / Q000276:immunology; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous