Management of the pregnant patient with idiopathic thrombocytopenic purpura

Abstract

Infants born to pregnant women with idiopathic thrombocytopenic purpura can develop thrombocytopenia, because the antiplatelet antibody that causes the illness can cross the placenta. The impact of this disease on pregnancy has been studied by analyzing case reports, but this method can give inaccurate estimates. In this report, we summarize the results of three prospective studies and one study of consecutive patients, and show that the risk for mother and fetus is lower than has been suggested. Maternal platelet count does not predict whether an infant will have thrombocytopenia but maternal platelet antibody level may be predictive. Corticosteroid therapy in the mother to raise the fetal platelet count, and measurement of the fetal scalp platelet count after elective amniotomy at term with delivery of the thrombocytopenic infants by cesarean section are two recommended approaches. Whether either approach has a significant impact on infant mortality is uncertain, because most fetal deaths occur early in pregnancy. Understanding the reasons for these fetal deaths might allow more effective treatment.