[Assessment of fetal well-being in pregnancies complicated by maternal moderate to severe thrombocytopenia].
OBJECTIVE
To analyze the results of assessment of fetal well-being in pregnancies complicated by moderate or severe maternal thrombocytopenia.


METHODS
Data from April 2001 to July 2011 of 96 women with a diagnosis of thrombocytopenia in pregnancy were retrospectively analyzed. We analyzed the following tests performed during the antepartum period for fetal assessment: cardiotocography, fetal biophysical profile, amniotic fluid index and umbilical artery Doppler velocimetry.


RESULTS
A total of 96 pregnancies with the following diagnoses were analyzed: gestational thrombocytopenia (n=37, 38.5%) hypersplenism (n=32, 33.3%), immune thrombocytopenic purpura (ITP, n=14, 14.6%), secondary immune thrombocytopenia (n=6, 6.3%), bone marrow aplasia (n=3, 3.1%), and others (n=4, 4.1%). Cardiotocography showed normal results in 94% of cases, a fetal biophysical profile with an index of 8 or 10 in 96.9% and an amniotic fluid index >5.0 cm in 89.6%. Doppler umbilical artery velocimetry showed normal results in 96.9% of cases. In the analysis of the major groups of thrombocytopenia, the diagnosis of oligohydramnios was found to be significantly more frequent in the group with ITP (28.6%) compared to the other groups (gestational thrombocytopenia: 5.4% and hypersplenism: 9.4%, p=0.04).


CONCLUSIONS
This study indicates that in pregnancies complicated by moderate or severe maternal thrombocytopenia, even though the fetal well-being remains preserved in most cases, fetal surveillance is important in pregnant women with ITP, with emphasis on amniotic fluid volume evaluation due to its association with oligohydramnios.
Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Roseli Mieko Yamamoto
RM
Nomura
Ana Maria Kondo
AM
Igai
Verbênia Nunes
VN
Costa
Seizo
S
Miyadahira
Marcelo
M
Zugaib
D000328:Adult; D005260:Female; D005323:Fetal Monitoring; D006801:Humans; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013921:Thrombocytopenia