Thrombotic thrombocytopenic purpura in pregnancy with maternal and fetal survival: case report

Article Abstract:

Thrombotic thrombocytopenic purpura (TTP) is a rare bleeding disorder characterized by a decreased number of platelets (blood clotting cells), red spots, bruises, bleeding into tissues, neurological symptoms, and kidney failure. A 25-year-old women in her 28th week of pregnancy was admitted to the hospital because of excessive bleeding from her gums and multiple bruises. Blood tests revealed a low platelet count, fragmented red blood cells, and decreased fibrinogen, a substance required for blood clot formation. While in the hospital, the patient had a nose bleed, headache, chest pain, limb numbness, and pain. The patient was diagnosed with TTP, and was given a blood transfusion containing fresh frozen plasma (the portion of the blood containing clotting factors). When the patient did not respond well, she was given plasmapheresis treatment, which involves removing blood plasma, treating it, and then reintroducing the plasma back into the body. By the third day the red blood cell and platelet cell counts began to increase, and on the 10th hospital day the patient went home and was maintained on aspirin therapy, dipyridamole (a drug that opens blood vessels), prednisone (an anti-inflammatory), ranitidine, and folic acid (essential for red blood cell production). A normal healthy infant was delivered at the 35th week of pregnancy. The patient remains healthy 18 months later. TTP in pregnant women can be similar in appearance to preeclampsia or disseminated intravascular coagulation. Preeclampsia was ruled out in this case because high blood pressure and increased protein in the urine were not evident; blood coagulation factors were not indicative of disseminated intravascular coagulation. The pathogenesis of TTP during pregnancy is not well-understood, since it is a rare occurrence. Pregnancy should be avoided by patients with TTP because platelet clumping increases when biochemical defects are present. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Thrombocytopenic purpura, Hematologic diseases, Blood diseases in pregnancy

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Congenital rubella after previous maternal immunity

Article Abstract:

Rubella, often called German measles, is a relatively minor viral disease, but represents a serious threat to the developing fetus. Immunization against rubella has dramatically decreased the number of birth defects caused by the virus, but has not eliminated them. It is quite possible for women who have been previously immunized to develop symptoms of rubella, but in these cases the disease is mild and is thought to carry no serious risk of fetal damage. However, in two recent cases, serious birth defects occurred in the infants born to women who had been shown to be immune to rubella. In one case, the mother had been immunized; in the other, there was no record of immunization, but assays performed for previous pregnancies demonstrated the presence of antibodies to rubella. One mother had no recollection of any rash, which might have been symptomatic of rubella. This is not uncommon; up to one quarter of women with babies affected by congenital rubella had no clinical symptoms, and reinfection is very often subclinical. Congenital rubella can produce microphthalmia, or small eyes, deafness, cataracts, and heart defects. Although it is possible for immunized pregnant women to develop rubella, this should not be interpreted as detracting from the general overall effectiveness of the available rubella vaccines. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Infection, Fetus

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Rubella infection in pregnancy: remaining problems

Article Abstract:

In the UK, routine immunization with the combination measles, mumps and rubella vaccine (MMR) was instituted to reduce the incidence of rubella infections in pregnant women. Rubella, contracted during pregnancy, can cause serious abnormalities in the fetus. Every year approximately 20 cases of congenital rubella syndrome and 100 to 200 diagnoses of rubella in pregnant women occur despite the widespread effort to provide MMR immunization. Failed immunization due to patient refusal may be partially responsible for this problem. It is suggested that women exposed to rubella, especially during the first four months of pregnancy, with or without symptoms or typical rash, be evaluated for the disease. Two percent of the 1,000 women reported to have rubella during 1983-1987 had immunological tests which confirmed previous exposure. Vaccine failure occurs in 2-5 percent of MMR immunizations. Some vaccine effects diminish over time, and such patients require re-immunization. Five cases of maternal reinfection with the rubella virus have been reported in the U.K. The effect of maternal reinfection on the fetus needs to be investigated; early studies demonstrate that the risk of fetal infection is less than ten percent. It is hoped that routine MMR immunization of young children will be the long-term solution for preventing rubella infections in pregnant women.

Health aspects, Standards, United Kingdom, Children, Communicable diseases, Immunization of children, Immunization, column, Great Britain, Communicable diseases in pregnancy

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