Immune thrombocytopenic purpura in pregnancy: a reappraisal of obstetric management and outcome.

OBJECTIVE: To evaluate the complications of pregnancy and perinatal outcome in women with idiopathic thrombocytopenic purpura (ITP).

STUDY DESIGN: A retrospective analysis of 38 singleton pregnancies, their course, obstetric management and perinatal outcome of 32 patients with known ITP was undertaken.

RESULTS: No major antenatal complications were noted among the patients. There were no maternal deaths, and only 1 stillbirth occurred in the series. Fourteen infants were delivered by cesarean section and 24 by vaginal delivery. Neonatal cord blood platelet count was performed in each of the live-born infants and revealed thrombocytopenia in 16 infants, but in only 6 (16.2%) of them was the cord blood platelet count < 50 x 10(9)/L. There was no neonatal death in the study, although 6 infants required supportive treatment with corticosteroids and intravenous immunoglobulin G. No maternal features could be used to predict the neonatal platelet count at birth. These results are comparable with other studies in the recent literature.

CONCLUSION: Due to the low incidence of poor neonatal outcome in mothers with ITP, obstetric intervention based solely on their platelet count is not justified. Every patient with ITP should be managed individually, and the routine use of cesarean section should be abandoned.