Submitted November 5, 2002
Accepted August 21, 2003
A retrospective, 11-year analysis of obstetrical patients with idiopathic thrombocytopenic purpura
Kathryn E Webert*, Richa Mittal, Christopher Sigouin, Nancy M Heddle, and John G Kelton
Department of Medicine, McMaster University, Hamilton, ON, Canada
* Corresponding author; email: webertk{at}mcmaster.ca.
Numerous studies have examined the outcomes of infants born to mothers with idiopathic thrombocytopenic purpura (ITP). Fewer studies have discussed the morbidity of obstetrical patients with ITP. We describe a retrospective study of 92 women with ITP during 119 pregnancies over an 11-year period. Most women had thrombocytopenia during pregnancy. At delivery, women in 98 pregnancies (89%) had platelet counts less than 150 x 109/L; most had mild to moderate thrombocytopenia. For many, the pregnancy was uneventful; however, there was moderate to severe bleeding in 25 pregnancies (21.5%). Thirty-seven pregnancies (31.1%) required treatment to increase platelet counts. Forty-four deliveries (37.3%) received epidural analgesia without complications with most having a platelet count between 50 and 149 x 109/L. The majority of deliveries (82.4 %) were vaginal. Bleeding was uncommon at delivery. Infant platelet counts at birth ranged from 12 to 436 x 109/L; 25.2% of infants had platelet counts less than 150 x 109/L and 9% had a platelet count less than 50 x 109/L. Eighteen infants (14.6%) required treatment for hemostatic impairment. Two fetal deaths occurred. One was due to hemorrhage. ITP in pregnancy carries a low risk, but mothers and infants may require therapy to raise their platelet counts.
