The Management of Immunologic Thrombocytopenic Purpura (ITP) During Pregnancy
Immunologic thrombocytopenic purpura (ITP), in which both mother and fetus are affected by an antibody which acts against platelets, is one of the major complications of pregnancy. The resultant thrombocytopenia may cause hemorrhage, not only in the mother but also in her fetus, because in some cases the antibody crosses the placenta which leads to fetal intracranial hemorrhage on vaginal delivery. The management of ITP during pregnancy has been controversial for the following reasons: Firstly, it is not clear whether pregnancy affects the natural course of ITP. Therefore, there is no clear-cut criteria for determining whether or not to terminate the pregnancy with the hope that ITP may be improved by this measure. Secondly, one has to consider the mode of delivery, because in the presence of maternal thrombocytopenia vaginal delivery is preferred, since this minimizes maternal blood loss and is thus less traumatic for the mother than cesarean section. In contrast, in the presence of fetal thrombocytopenia, although the incidence of severe fetal thrombocytopenia has been reported to be low, cesarean section is better. However it has been reported that there is not a strong correlation between fetal and maternal platelet counts . This evidence makes the problem more complicated.
KeywordsPlatelet Count Cesarean Section Vaginal Delivery Platelet Transfusion Antiplatelet Antibody
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