Immune thrombocytopenic purpura in pregnancy: a reappraisal of management

Article Abstract:

Immune thrombocytic purpura (ITP) is a condition that complicates 1 or 2 of every 1,000 pregnancies in which the mother's antibodies against blood platelets (cells essential for clotting) cross the placenta and destroy fetal platelets. Complications for the fetus with thrombocytopenia (low numbers of platelets, or thrombocytes) can include hemorrhage within the skull; the newborn is at risk during the few weeks of life as well. This report details the authors' experience with pregnant women with ITP during a 10-year period; it includes a review of relevant medical literature that covers 20 years. Twenty-five women with 31 pregnancies and 32 liveborn infants were studied. Eleven women had been previously diagnosed with ITP and eight were first diagnosed during pregnancy. Fourteen births were vaginal deliveries and 18 infants were delivered by cesarean section. Six of the cesarean deliveries were associated with major complications, including wound infections, very high fevers in the mother, and uterine inflammation. No major complications occurred in the women who had vaginal deliveries. Three of the infants had moderate thrombocytopenia and two had severe thrombocytopenia, but none developed significant complications. The authors could not identify any maternal characteristic that predicted which infants would develop this abnormality. The literature review, covering 474 infants born to mothers with ITP, revealed that 10 percent were born with moderate, and 15 percent with severe thrombocytopenia. Three percent of these infants developed intracranial hemorrhage, with no relation observed between hemorrhage and the mode of delivery (vaginal versus cesarean). This is a matter of importance since it can be difficult to tell whether hemorrhage begins before, during, or after delivery. In general, the probability of intracranial hemorrhage rose as the platelet count declined. The authors conclude that it is likely that the risks of cesarean delivery are greater than any benefits conferred by this procedure, and recommend that physicians manage women with ITP according to standard obstetrical guidelines. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Risk factors, Hemorrhage, Thrombocytopenic purpura

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Catecholamine levels in pregnant physicians and nurses: A pilot study of stress and pregnancy

Article Abstract:

Physical and mental stress may affect the body in many ways, but in pregnant women, stress has been associated with increases in complications such as low birth weight, premature labor and preterm birth. A sign of stress is increased blood levels of catecholamines, including adrenaline (epinephrine) and norepinephrine; urine levels of these substances can be tested since they reflect the blood levels accurately. The urinary catecholamine levels were measured in 25 pregnant women (average of 30 weeks gestation) who were divided into two groups according to stress level on the job. The stressed group included 10 physicians and three intensive care unit (ICU) nurses, and the unstressed, control group included 12 women with jobs that did not require prolonged standing or lifting (secretaries, graduate students, research nurses). In both groups, urine specimens were collected over 24 hours on work days. In addition, the stressed group collected specimens on non-work days. Catecholamine levels were not different between the non-work days of the stressed group and the work days of the control group. However, during working hours for the stressed group, catecholamine levels increased by 58 percent compared with their non-working days. On work days, catecholamine levels were also 64 percent higher in the stressed group than the control group. Daily catecholamine production depends on daily activity and in general is a direct reflection of the stress level of the patients. Both mental stress (such as making difficult decisions) and physical stress (such as standing) stimulate the catecholamine levels. Catecholamines have the effect of decreasing blood flow in the uterus. This study showed that urinary catecholamine levels of pregnant physicians and ICU nurses were greater during working hours than non-working hours and supports the theory that catecholamine levels and stressful work are associated. However, the number of subjects was small and catecholamine levels on work days were only measured once for each subject; larger studies of this topic are needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Nurses, Employment, Pregnant women, Job stress, Women physicians, Catecholamines

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A comparison of bed rest and immersion for treating the edema of pregnancy

Article Abstract:

Most pregnant women experience edema (swelling due to retained fluid) of the legs to some extent, a condition usually treated by elevating the legs. This results in increased re-absorption of the fluid into the circulatory system and subsequent excretion via the kidneys. Immersion in water also reduces edema by hydrostatic pressure, which forces fluid into the vascular system. This force acts immediately upon immersion and results in considerable diuresis (urination) in pregnant women. A comparison was made of the effects of bed rest, waist-deep immersion and shoulder-deep immersion on fluid mobilization on healthy pregnant women at 34 to 38 weeks' gestation. Movement of fluid in the tissues into the circulatory system was assessed by measuring the amount of urine produced after the treatment. Eleven women participated in the study and each was evaluated after each treatment, with the treatments spaced two to four days apart. The treatments consisted of lying on the side, sitting in a standard bathtub with the water at approximately 32 degrees Centigrade, or sitting in a specially constructed tank with shoulder-deep water at the same temperature. Treatments lasted 50 minutes. Heart rate and blood pressure were monitored. One hour after the beginning of the treatment, the women urinated and their urine was analyzed. Blood samples were taken within 10 minutes of the end of treatment. Results showed that diuresis was significantly greater for subjects in the immersion tank (242 milliliters) than in the bathtub (161 milliliters) or after bed rest (105 milliliters). In addition, shoulder-deep immersion led to a greater reduction in blood pressure (mean arterial pressure, MAP) than did either of the other treatments, although both produced decreases. It thus appears that immersion is an effective treatment for the edema of pregnancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Edema, Immersion

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