How is immune thrombocytopenic purpura (ITP) platelet disorder managed in pregnancy?

Updated: Aug 05, 2017
  • Author: Perumal Thiagarajan, MD; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

Answer

The optimal management of immune thrombocytopenic purpura (ITP) during pregnancy is considerably controversial. Most pregnant women with ITP are treated with steroids and have relatively few complications involving the fetus and mother. [4]

Patients whose condition is resistant to prednisone can be treated with IVIG. Splenectomy has been performed during pregnancy but should be avoided whenever possible. A platelet count of 50,000/µL is usually sufficient for major surgeries, including splenectomy and cesarean delivery.

The overriding concern is thrombocytopenia developing in the fetus. The IgG autoantibodies in ITP can cross the placenta and may cause thrombocytopenia in the fetus. In most recent studies of ITP complicating pregnancy, severe fetal thrombocytopenia has been uncommon. However, thrombocytopenia is occasionally observed in infants born from mothers who have thrombocytopenia.

No laboratory parameter helps predict the platelet count in the fetus. Previous obstetric history is the only useful predictor. The platelet count of the fetus before delivery can be determined by fetal scalp sampling or percutaneous cord blood sampling.

However, these are invasive procedures associated with serious complications, carrying a risk of intracranial hemorrhage similar to or higher than that of ITP due to neonatal thrombocytopenia. Further, platelets are often clumped, leading to spuriously low platelet count and unnecessary cesarean delivery.


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