title: A retrospective 11-year analysis of obstetric patients with idiopathic thrombocytopenic purpura.
abstract: Numerous studies have examined the outcomes of infants born to mothers with idiopathic thrombocytopenic purpura (ITP). Fewer studies have discussed the morbidity of obstetric patients with ITP. We describe a retrospective study of 92 women with ITP during 119 pregnancies over an 11-year period. Most women had thrombocytopenia during pregnancy. At delivery, women in 98 pregnancies (89%) had platelet counts lower than 150 x 109/L; most had mild to moderate thrombocytopenia. For many, the pregnancy was uneventful; however, women had moderate to severe bleeding in 25 pregnancies (21.5%). Women in 37 pregnancies (31.1%) required treatment to increase platelet counts. During delivery, 44 women (37.3%) received epidural analgesia without complications, with most having a platelet count between 50 and 149 x 109/L. Most deliveries (82.4%) were vaginal. Bleeding was uncommon at delivery. Infant platelet counts at birth ranged from 12 to 436 x 109/L; 25.2% of infants had platelet counts lower than 150 x 109/L, and 9% had platelet counts lower than 50 x 109/L. Eighteen infants (14.6%) required treatment for hemostatic impairment. Two fetal deaths occurred. One was caused by hemorrhage. ITP in pregnancy carries a low risk, but mothers and infants may require therapy to raise their platelet counts.
authors.affiliation: Department of Medicine, McMaster University, Rm HSC-3N43, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5. webertk@mcmaster.ca
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Webert
authors.forename: Richa
authors.initials: R
authors.lastname: Mittal
authors.forename: Christopher
authors.initials: C
authors.lastname: Sigouin
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Heddle
authors.forename: John G
authors.initials: JG
authors.lastname: Kelton
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D015360:Analgesia, Epidural / Q000706:statistics & numerical data; D016362:Analgesia, Obstetrical / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D005313:Fetal Death / Q000209:etiology; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007231:Infant, Newborn; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000151:congenital; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents