Introduction: Immune thrombocytopenia (ITP) is associated with alterations in the immune system
at the maternal–fetal interface which promote tolerance of shared fetal–paternal alloantigens
through a shift toward the predominance of type 2 helper T cells. IgG antiplatelet
antibodies accelerate platelet clearance and reduce platelet production. An impairment
in platelet production has been suggested on the basis of the elevated estradiol and
serum thrombopoietin levels in pregnant women with ITP , may be from placental source.
ITP Prevalence is more than 1 million cases globally, commonly in women of childbearing
age. Even during uncomplicated pregnancies with ITP, platelet counts may fall, platelet
clearance may be accelerated, surgical delivery may be required, and IgG antiplatelet
antibodies can also be transported across the placenta to the fetus. These factors
complicate the diagnosis and management of ITP in pregnancy and require a multidisciplinary
approach.
Method: We collected data of 95 pregnancies over last 15 years retrospectively who were managed
in special antenatal clinic of medical-surgical disorders Post Graduate Institute
of Medical Education & Research, Chandigarh. Autoimmune work up was done in all patients.Platelet
count was done at regular intervals of 3-4 weeks, dose of steroids was altered accordingly.
Steroids were the mainstay of treatment after diagnosis, tapered to maintenance dose
in pregnacy. Autoimmune work up was done in all patients. Platelet transfusion(random
donor platelets/ SDAP-single donor apheresis) was done in symptomatic patients, those
requiring intervention/delivery or surgical procedure, count<10000 and to maintain
a count of>20000 during pregnancyin asymptomatic women IVIG and Pulse Methyl prednisolone
was given as per consultation with haematologist [1]
[2]
[3]
[4]
[5]
[6].
Results: Age group was 25.3±4.8 years, 90.2% were multiparous.<6.3% diagnosed during index pregnancy.93% were diagnosed
prenatally-36.8% due to wet purpura, 15.7% for dry purpura with significant thrombocytopenia<15
k. Bone marrow aspirate was diagnostic in 34.7%. 47.3% were on maintainance steroids
in pregnancy. Dapsone(6) and Danazol(7) were also given in prenatal period only. 6/95
received steroid pulse therapy and 9/95 received IVIG for low counts. Splenectomy
was done for chronic ITP with splenomegaly in 16.95%, all before pregnancy and they
did not require any further treatment in pregnancy. Labour was managed under SDAP
cover, 65.2% delivered vaginally, 33.6% caesarean for obstetric indications. Neonatal
outcome was 90% term , 2.6-3.1 kg birth weightneonates. No maternal or neonatal complications
due to thrombocytopenia were observed.
Conclusion: ITP is not a contraindication for pregnancy. Monitoring platelet count and appropriate
intervention with drugs, supportive transfusions help achieve optimal maternal and
neonatal outcomes.Maintainig an adequate platelet count with supportive tansfusions
helps preventing complications and achieve optimal feto-maternal outcome
