The influences of mothers with moderate and severe gestational thrombocytopenia and primary immune thrombocytopenia on neonates / 中国新生儿科杂志

Objective:To study the effects of maternal moderate and severe gestational thrombocytopenia (GT) and primary immune thrombocytopenia (ITP) on neonates.Method:From Jan 2018 to Dec 2019, pregnant women with platelet count <100×10 9/L during pregnancy admitted to our hospital were retrospectively reviewed. The infants were assigned into GT group and ITP group according to their mothers' diagnoses. The clinical outcomes were compared between the two groups. Result:Of 104 mothers with platelet count <100×10 9/L, 32 (30.8%) were diagnosed with ITP and 72 (69.2%) with GT. Gestational age (GA) of the ITP group was smaller than the GT group [(37.0±1.5) weeks vs. (38.0±2.0) weeks, P<0.05]. The maternal platelet count within 24 h before delivery (39×10 9/L vs. 86×10 9/L) and the lowest platelet count during pregnancy (17×10 9/L vs. 75×10 9/L) in the ITP group were both lower than the GT group, the differences were statistically significant ( P<0.001). The maternal platelet count after birth in ITP group were lower than the GT group (184×10 9/L vs. 277×10 9/L, P<0.01). Neonates in the ITP group have an increased tendency to develop neonatal thrombocytopenia (NT) than the GT group (43.8% vs. 6.9%, P<0.001). The platelet count on the first day after birth (92×10 9/L vs. 170×10 9/L) and the lowest platelet count (43×10 9/L vs. 103×10 9/L) of NT newborns in the ITP group were lower than the GT group ( P<0.05). No differences existed for the time needed reaching the lowest platelet count in NT newborns between the two groups [(3.5±1.2) d vs. (4.4±0.4) d, P>0.05]. Neither group had intracranial hemorrhage. Conclusion:Neonates born to pregnant mother with platelet count <100×10 9/L have a tendency to develop NT. The incidence of NT in neonates born to mothers with ITP is higher than GT, but the overall prognosis of the newborns is good.

Fetomaternal outcome in pregnancy with gestational thrombocytopenia: a cross sectional study

Background: Thrombocytopenia is second to anemia as the most common haematological abnormality during pregnancy. Objective of this study was to study the clinical profile, maternal and perinatal outcomes in thrombocytopenic antenatal patients.Methods: A prospective study was carried out in tertiary hospital, 280 pregnant women who attended the Antenatal clinic regularly were enrolled. All were screened for thrombocytopenia in third trimester (after 28 weeks), women with normal platelet (n=140) were taken in control group and those with low counts less than 150×109/L (n=140) were included in study group. Maternal and fetal outcome of thrombocytopenia in third trimester of pregnancy were studied.Results: Majority of women with gestational thrombocytopenia had mild thrombocytopenia (70.71%). 30.72% patients with thrombocytopenia had hemorrhagic manifestations. Maternal and perinatal complications like PPH (27.14%), puerperial sepsis (9.28%), placental abruption (5%), need for transfusion (20%), neonatal jaundice (20%), neonatal thrombocytopenia (12.14%), birth asphyxia (12.86%), NICU admission (12.14%), low Apgar (37.14%), need for resuscitation (30%), were more in patients with thrombocytopenia as compared to their age and parity matched controls.Conclusions: According to this study results, pregnancies with gestational thrombocytopenia, as compared to the control group, were at a higher risk of cesarean section, intrauterine fetal death, preterm delivery, low Apgar scores, more NICU admission rate, intracranial hemorrhage, neonatal death, or adverse maternal outcome.

Study of thrombocytopenia in pregnancy: clinical presentation and outcome at tertiary care rural institute

Background: Platelet count below 1.5 lakh/cumm is called as thrombocytopenia. After anaemia it is the second most common haematological disorder in pregnancy. It affects nearly 6 to 15%; on an average 10% of all pregnancies. Gestational thrombocytopenia is a clinically benign thrombocytopenic disorder usually occurring in late pregnancy. It resolves spontaneously after delivery.Methods: It is a hospital based prospective observational study over a period of 1 year. All pregnant women who attended OPD at the department of obstetrics and gynecology, UPUMS, Saifai for antenatal checkup were included for the study and blood sample was withdrawn.Results: Out of 263 cases enrolled for study, 90 women were found to have thrombocytopenia, and 173 had normal platelet count. Thus, incidence of thrombocytopenia was 34%. Gestational thrombocytopenia accounted for majority of cases of thrombocytopenia in pregnancy (50%) followed by hypertensive disorders (22.4%). It was further followed by ITP (11.11%) and dengue (5.5%).Conclusions: Gestational thrombocytopenia is the most common cause of thrombocytopenia during pregnancy (50%), but other underlying causes must be considered as well. A thorough history and physical examination will rule out most causes.

Thrombocytopenia at different stages of pregnancy.

Thrombocytopenia is a common finding in pregnancy, occurring in approximately 10 – 16 % of women. The normal range of platelet counts decreases, and it is not uncommon for the platelet counts to decrease as pregnancy progresses. Lower platelet count observed in the pregnant are due to normal physiologic changes, and has many common causes including gestational thrombocytopenia, viral and bacterial infection and preeclampsia complicated by hemolysis. Objective: the objective was to investigate thrombocytopenia during different stages of pregnancy. Materials and methods: Sixty three pregnant women were included in this study from different clinic in Derna city. Mean age (28 ± 1.4) year with a range (20 – 1.4) year. At the same time a group of Sixty three healthy non pregnant women mean age ( 29 ± 2.2 ) with a range ( 23 – 45 ) year to compare platelets count between them. By automated cell counter platelets from all pregnant and non pregnant were estimated. Results: Pregnant women had lower platelets count (mean 193× 109/l) as compared to healthy non pregnant women (mean 250 × 109/l). There was significant decrease in platelet count in pregnant as compare with non pregnant P ≤ 0.001. Conclusion: Platelet counts were performed on sixty three normal patients at different stages of pregnancy. Patients with complications of pregnancy known to influence the platelet count were excluded from the study. There was significant decrease in platelet count during pregnancy.

Trombocitopenias y embarazo. Dilemas diagnósticos, bases del manejo terapéutico / Thrombocytopenias and pregnancy. Diagnostic dilemmas, rationale for the therapeutic management

El hallazgo de una plaquetopenia durante la gestación siempre genera preocupación. Para el clínico es un desafío diagnóstico debido a la multiplicidad de etiologías que se deben considerar. En esta revisión se repasan las distintas causas de trombocitopenia en el embarazo y se mencionan las bases de su manejo terapéutico. Se aborda la definición y posibles causas de la trombocitopenia gestacional así como su significado y manejo clínico. A continuación se describen las complicaciones gestacionales que cursan con trombocitopenia así como las bases de su manejo. De estos cuadros se jerarquizan los estados hipertensivos del embarazo, especialmente la preeclampsia y el HELLP así como las microangiopatías trombóticas del embarazo y el síndrome antifosfolipídico. Posteriormente se reseñan las repercusiones recíprocas del púrpura trombocitopénico inmune y la gestación así como los aspectos relevantes del diagnóstico y la conducta terapéutica cuando está indicada. Se finaliza mencionando causas raras de trombocitopenia durante el embarazo.

The Clinical Features and Neonatal Outcomes of Thrombocytopenia in Pregnancy / 대한주산의학회잡지

OBJECTIVE: The aim of this study was to evaluate the proper management based on 6 years of experience in Inje University Ilsan Paik Hospital by review of the clinical features of thrombocytopenia in pregnancy. METHODS: A survey about causing factors, diagnosis, obstetric outcomes and management of thrombocytopenia in pregnancy at Inje University Ilsan Paik Hospital from December 1999 to September 2005 was done by retrospectively. RESULTS: The total number of delivery was 3002 and total number of thrombocytopenia in pregnancy was 70 (2.3%), of which 37 were gestational thrombocytopenia and 10 were ITP. The thrombocytopenia associated with PIH was 21, pancytopenia was 1 case, and thrombocytopenia associated with liver cirrhosis was 1 case. The obstetric and perinatal outcomes were similar between groups. But 1 case of ITP pregnancy, there was neonatal intraventricular hemorrhage was observed. CONCLUSION: Gestational thrombocytopenia is the most common cause of thrombocytopenia. It is characterized by mild maternal thrombocytopenia and is not associated with adverse maternal or fetal outcomes. The ITP patients should be carefully monitored during the antenatal care visits, also preeclampsia, HELLP, and the primary thrombotic microangiopathies need careful monitoring, but these disease can be differentiated from one another in most cases.

Differential diagnosis of Thrombocytopenia newly developed during pregnancy / 대한산부인과학회지

OBJECTIVE: Gestational thrombocytopenia has a mild course as a common problem during pregnancy, whereas idiopathic thrombocytopenic purpura (ITP) presents with a chronic or moderate to severe course. Very few studies have been conducted so far to discriminate between the two diseases. This study was aimed to identify factors predictive of the subsequent development of ITP among pregnant women presenting with thrombocytopenia. METHODS: From January 1999 to June 2005, a total of 58 pregnant women newly diagnosed with thrombocytopenia were recruited for the study. Among them, 33 were finally diagnosed with gestational thrombocytopenia and the other 25 with ITP. The clinical factors for each of ITP and neonatal thrombocytopenia were evaluated, and final outcomes were also described. RESULTS: On multivariate analysis, thrombocytopenia diagnosed before 28 completed weeks and platelet count of less then 50 x 10(9)/L at the time of its presentation were found to be independently predictive of ITP (p<0.001 and p=0.004 respectively). In addition, platelet count of less then 20 x 10(9)/L at nadir during pregnancy was a significant risk factor for neonatal thrombocytopenia (p=0.013). CONCLUSION: The onset time of thrombocytopenia and platelet count at its presentation remain useful parameters to discriminate ITP from gestational thrombocytopenia. These findings may help in allowing an appropriate antenatal care and postpartum follow up.

A Case of Delivery of Severe Gestational Thrombocytopenia / 대한산부인과학회잡지

The pathogenesis of thrombocytopenia in the gestational thrombocytopenia is not understood.This syndrome may represent either the de novo development of ITP or an accelerationof the physiologic pattern of increased platelet destruction that occurs during gestation. Thisdisorder is not easily distinguishable from classical ITP. However, the recognition and diagnosisof this syndrome is important because infants born to individuals with gestational thrombocytopeniaappear to have a markedly reduced risk of developing thrombocytopenia when comparedto infants born to patients with a history of ITP antedating pregnancy. We represent a caseof delivery in severe gestational thrombocytopenia with brief review of the literature.