title: Antenatal interventions for fetomaternal alloimmune thrombocytopenia.
abstract: BACKGROUND
  Fetomaternal alloimmune thrombocytopenia results from the formation of antibodies by the mother which are directed against a fetal platelet alloantigen inherited from the father. The resulting fetal thrombocytopenia (reduced platelet numbers) may cause bleeding, particularly into the brain, before or shortly after birth. Antenatal treatment of fetomaternal alloimmune thrombocytopenia includes the administration of intravenous immunoglobulin (IVIG) and/or corticosteroids to the mother to prevent severe fetal thrombocytopenia. IVIG and corticosteroids both have short-term and possibly long-term side effects. IVIG is also costly and optimal regimens need to be identified.
  
  
  OBJECTIVE
  To determine the optimal antenatal treatment of fetomaternal alloimmune thrombocytopenia to prevent fetal and neonatal haemorrhage and death.
  
  
  METHODS
  We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 February 2011) and bibliographies of relevant publications and review articles.
  
  
  METHODS
  Randomised controlled studies comparing any intervention with no treatment, or comparing any two interventions.
  
  
  METHODS
  Two review authors independently assessed eligibility, trial quality and extracted data.
  
  
  RESULTS
  We included four trials involving 206 people. One trial involving 39 people compared a corticosteroid (prednisone) versus IVIG alone. In this trial, where analysable data were available, there was no statistically significant differences between the treatment arms for predefined outcomes. Three trials involving 167 people compared IVIG plus a corticosteroid (prednisone in two trials and dexamethasone in one trial) versus IVIG alone. In these trials there was no statistically significant difference in the findings between the treatment arms for predefined outcomes (intracranial haemorrhage; platelet count at birth and preterm birth). Lack of complete data sets and important differences in interventions precluded the pooling of data from these trials.
  
  
  CONCLUSIONS
  The optimal management of fetomaternal alloimmune thrombocytopenia remains unclear. Lack of complete data sets for two trials and differences in interventions precluded the pooling of data from these trials which may have enabled a more developed analysis of the trial findings. Further trials would be required to determine optimal treatment (the specific medication and its dose and schedule). Such studies should include long-term follow up of all children and mothers.
authors.affiliation: Arthur Bloom Haemophilia Centre, University Hospital of Wales, Cardiff and Vale NHS Trust, Heath Park, Cardiff, UK, CF14 4XW.
authors.forename: Rachel
authors.initials: R
authors.lastname: Rayment
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Brunskill
authors.forename: Peter W
authors.initials: PW
authors.lastname: Soothill
authors.forename: David J
authors.initials: DJ
authors.lastname: Roberts
authors.forename: James B
authors.initials: JB
authors.lastname: Bussel
authors.forename: Michael F
authors.initials: MF
authors.lastname: Murphy
mesh_terms: D016824:Antigens, Human Platelet / Q000276:immunology; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D005315:Fetal Diseases / Q000188:drug therapy* / Q000276:immunology; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D011241:Prednisone / Q000627:therapeutic use*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D013921:Thrombocytopenia / Q000188:drug therapy* / Q000276:immunology; D054098:Thrombocytopenia, Neonatal Alloimmune / Q000188:drug therapy / Q000276:immunology
chemical_list: D016824:Antigens, Human Platelet; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D003907:Dexamethasone; D011241:Prednisone