Low fetal risks in pregnancies associated with idiopathic thrombocytopenic purpura

Article Abstract:

Idiopathic thrombocytopenic purpura (ITP) is a bleeding disorder involving a decrease in blood levels of platelets, cells important for clotting. The disorder is caused by formation of certain antibodies (IgGs, a type of immunoglobulin) that recognize platelets and lead to their destruction. ITP is common in young women and thus is often a disease encountered by physicians treating pregnant women. The IgGs can cross the placenta, and infants may be born with varying degrees of thrombocytopenia. Frequently, obstetrical delivery practice may be altered, such as by means of cesarean section, to minimize complications associated with thrombocytopenia, but this may frequently be unnecessary or even associated with more complications. The outcomes of 60 pregnancies with ITP were evaluated in order to better understand how deliveries should be modified to deal with the condition. Three quarters of the women had thrombocytopenia at delivery, but none had serious illness. Sixteen were treated with steroids. The rate of cesarean sections was 35 percent. Thrombocytopenia occurred in only 14.8 percent of newborns, a rate much lower than previously suggested. However, platelet levels continued to fall in 66 percent of infants, with lowest levels being reached by the first or second day of life. Five infants were given intravenous IgG (gamma globulin) due to low platelet levels. There was no correlation between the platelet counts of mothers and their infants. No infant bled or had other untoward events. The outcomes of these infants were less complicated than those that have been previously reported, for reasons which are unclear. The study suggests that interventions in obstetrical delivery are generally unnecessary in cases of pregnancy with ITP, but that platelet levels of infants should be closely monitored for the first week of life. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Prognosis, Gamma globulins

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Thrombocytopenia at delivery:a prospective survey of 6715 deliveries

Article Abstract:

Thrombocytopenia is a decreased number of platelets, cells involved in the clotting process. The most common manifestation of thrombocytopenia is bleeding. An earlier study found that thrombocytopenia in healthy pregnant women was relatively common and required no treatment. Therefore, routine cesarean section was not generally indicated. Since long-term problems can result when low platelet counts in infants go undiagnosed, it is essential to know the incidence of thrombocytopenia in infants born to mothers with thrombocytopenia. Over a three-year period, all women entering one obstetrical service had a total blood count. Out of 6,715 deliveries, 513 (7.6 percent) mothers had thrombocytopenia. The mothers were divided into two groups. One group consisted of mothers who had no underlying medical condition or history of a bleeding disorder when the thrombocytopenia was found (65.1 percent). The other group consisted of mothers who were healthy but had a medical condition found during pregnancy such as early labor and diabetes of pregnancy. There was no excessive bleeding found among the mothers or infants in either group. From the 494 platelet counts obtained from fetal umbilical cord bloods, it was seen that 7.9 percent of infants born to both groups had low platelet counts. The smallest group of patients, representing 21 percent of the mothers with thrombocytopenia, had high blood pressure and idiopathic thrombocytopenic purpura (ITP, in which an immune response is mounted against the patient's own platelets, causing multiple bruises). In this group there were two infants with very low platelet counts but no bleeding. Therefore, incidental thrombocytopenia in healthy pregnant women, which is relatively common, does not affect the health of the mother or infant at delivery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Pregnancy, Thrombocytopenia, Hematologic diseases, Blood diseases in pregnancy

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The feasibility of a control population for a randomized control trial of seizure prophylaxis in the hypertensive disorders of pregnancy

Article Abstract:

The use of a control group may be ethical and necessary to determine the effectiveness of antiseizure medication in pregnant women with preeclampsia. Preeclampsia is a complication of pregnancy involving high blood pressure and protein in the urine. Researchers studied 1,559 pregnant women with hypertension who did not receive antiseizure medications. Twenty-one (1.4%) of these women had seizures, none of them resulting in death of mothers or fetuses. This suggests that since the rate of seizures in this population may be acceptably low and may not result in death, it may be safe to randomly assign women to either a control group or to an antiseizure medication group to test the effectiveness of antiseizure medications.

Health aspects, Methods, Clinical trials, Drug therapy, Preeclampsia, Anticonvulsants

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