[Idiopathic thrombocytopenia during pregnancy. The risk in connection with umbilical blood sampling is probably greater than the benefit].
Some fetuses whose mothers have idiopathic thrombocytopenic purpura (ITP) may themselves have low platelet count and are thought to be at risk of serious bleeding complications, especially intracranial bleeding, during vaginal delivery. The aim of the present study was to prospectively evaluate outcome for mothers with ITP and their neonates with or without the information provided by percutaneous umbilical blood sampling (PUBS). Our intention was to perform cordocentesis using PUBS to measure fetal platelet count in pregnant women with ITP, utilizing the information thus derived as an aid in planning for delivery. Thirty-five pregnancies in 34 women with ITP or low platelet count (< 105 x 10(9)/L) were monitored. PUBS was to be performed on 13 women only, five of whom were splenectomized. There were two complications related to the PUBS itself which led to cesarean sections on the same day. Twelve of the 13 fetuses with PUBS had platelet count greater than 50 x 10(9)/L in the 36th week of pregnancy, and vaginal deliveries were initially planned. After experiencing one serious complication with PUBS, we found it difficult for ethical reasons to perform PUBS on mothers with ITP. Therefore 22 pregnancies were monitored without PUBS. Nine of the 35 children (26%) were delivered by cesarean section. The frequencies of vaginal and cesarean deliveries in the groups with and without PUBS were the same. Six of 15 neonates (40%) born to splenectomized mothers had platelet counts less than 50 x 10(9)/L during the first days of life and four of these were treated with intravenous gamma globulin and/or cortisone. No intracranial bleeding was observed in any of the children. In our hands, PUBS in ITP is potentially harmful and must be questioned. The frequency of low platelet count and/or bleeding complications in neonates of mothers with ITP born vaginally is low. In our opinion, the mode of delivery should be chosen mainly on the basis of obstetric criteria.
Wegnelius
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G
Kvinnokliniken, Södersjukhuset, Stockholm. gisela.wegnelius@kk.sos.se
Elinder
G
G
D001800:Blood Specimen Collection / Q000009:adverse effects*; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005312:Fetal Blood / Q000166:cytology*; D006801:Humans; D007231:Infant, Newborn; D010976:Platelet Count; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis*; D011446:Prospective Studies; D012307:Risk Factors; D013156:Splenectomy; D013920:Thrombocythemia, Essential / Q000097:blood* / Q000150:complications
Idiopatisk trombocytopeni under graviditet. Risken vid provtagning i navelsträngen sannolikt större än vinsten.