Perinatal and neonatal aspects of maternal idiopathic thrombocytopenic purpura

Abstract

The pregnant woman with idiopathic thrombocytopenic purpura (ITP) and her fetus-neonate present a number of challenging issues for both the perinatologist and neonatologist. A review of these issues within a single format is helpful because of the widely scattered nature of the pertinent information in the medical literature. Maternal ITP is described herein as chronic, idiopathic, immune thrombocytopenic purpura, and the multiple interactions between ITP and pregnancy are detailed. The chief effect of maternal ITP on the fetus-neonate is thrombocytopenia, which occurs in approximately 37% of infants born to mothers with ITP. Using available literature, the pathophysiology, natural course, and therapy for maternal ITP-induced neonatal thrombocytopenia are described. Because affected infants may be severely thrombocytopenic at birth and at risk for hemorrhagic symptoms secondary to the stress of vaginal delivery, cesarean section is advocated as the preferred route of delivery for mothers with ITP. This approach is controversial, however, principally because many cesarean sections are productive of unaffected or mildly affected neonates. The predelivery use of fetal blood sampling and the presence of maternal circulating (unbound) antiplatelet antibody in this setting may provide the perinatologist guidance as to the appropriate delivery route for the at-risk thrombocytopenic infant.