Association between Fetal Cerebral Ventriculomegaly and Platelet Alloimmunisation.
BACKGROUND
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a rare condition that may lead to intracerebral haemorrhage (ICH) in the fetus or neonate. Platelet alloimmunisation causing FNAIT has been described in association with fetal cerebral ventriculomegaly (VM), presumably due to subclinical ICH. The objective of this study was to assess the association between fetal VM and platelet alloimmunisation.


METHODS
This is a case series of pregnancies with fetal VM screened for platelet alloantibodies from 2003 to 2012. Cases of multiple pregnancies, structural anomalies, aneuploidies, or congenital infection were excluded.


RESULTS
Of 45 pregnancies with fetal VM that were screened for platelet alloantibodies, 5 (11%) were positive. There was only one antenatal ICH, with confirmed fetal severe thrombocytopenia before termination of pregnancy. The other cases were treated with intravenous immunoglobulins without prior fetal blood sampling. No other case of neonatal thrombocytopenia was confirmed.


CONCLUSIONS
The prevalence of platelet alloimmunisation was high in this series of fetal VM. Prospective large studies are needed to confirm the role of platelet alloimmunisation in fetal VM.
Department of Obstetrics and Gynecology, CHU Sainte Justine, Université de Montréal, Montreal, Que., Canada.
Gabriella
G
Martillotti
Francoise
F
Rypens
Michele
M
David
Nancy
N
Catalfamo
Johanne
J
Dubé
Catherine
C
Taillefer
Christian
C
Lachance
François
F
Audibert
D000328:Adult; D015551:Autoimmunity; D000074042:Cerebral Intraventricular Hemorrhage / Q000000981:diagnostic imaging / Q000196:embryology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000196:embryology / Q000503:physiopathology / Q000628:therapy*; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007518:Isoantibodies / Q000032:analysis; D008279:Magnetic Resonance Imaging; D008297:Male; D062145:Maternal Serum Screening Tests; D008499:Medical Records; D011247:Pregnancy; D015995:Prevalence; D012189:Retrospective Studies; D013557:Switzerland / Q000453:epidemiology; D062606:Tertiary Care Centers; D054098:Thrombocytopenia, Neonatal Alloimmune / Q000453:epidemiology / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D016216:Ultrasonography, Prenatal
D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies
Fetal and neonatal alloimmune thrombocytopenia; Fetal cerebral ventriculomegaly; Intracerebral haemorrhage; Platelet alloimmunisation; Ultrasound