[Immune thrombocytopenia and pregnancy: State of knowledge and unanswered questions]. / Purpura thrombopénique immunologique et grossesse : état des connaissances actuelles et questions encore sans réponse.

Pregnancy is a common problem in women with immune thrombocytopenia (ITP). It could be a source of anxiety for the patients and their family, nurses and medical doctors and many questions are unresolved in this setting. Most of published recommendations were based on experts' opinion rather than on evidence-based medicine and randomized studies. The objectives of this article are to remind the known recommendations and to discuss the unresolved questions and the prospective.

[Thrombocytopenia and pregnancy]. / Thrombopénie et grossesse.

The occurrence of thrombocytopenia during pregnancy is frequent (about 10%). Etiologies of thrombocytopenia are dominated by the gestational thrombocytopenia (>75%), which requires no exploration and no specific treatment; it usually occurs during the last trimester of pregnancy and corrects itself spontaneously after delivery. Other etiologies are: (1) immune thrombocytopenia (ITP) either primary or associated with other pathologies; ITP may appear early in the first trimester of pregnancy, (2) thrombotic microangiopathy syndromes, and (3) obstetric thrombocytopenia: eclampsia and HELLP syndrome (hemolysis elevated liver enzymes, and low platelet count). Treatment of pre-eclampsia and HELLP syndrome is based on resuscitative measures and symptomatic fetal extraction that will be discussed according to the term and severity of the case. The treatment of microangiopathy is based on resuscitation and plasma exchange. For ITP, no specific action is needed during pregnancy and only symptomatic patients with a platelet count less than 30×10(9)/L must receive a treatment. It is important to prepare the childbirth that can be vaginally except if there is an obstetric contraindication. A platelet count of 50×10(9)/L is required for the delivery, and of 75×10(9)/L in case of spinal anesthesia. Treatment implies a short course of corticosteroids associated with infusion of immunoglobulins in the most severe forms or in case of steroids resistance. There is a risk of neonatal thrombocytopenia requiring a control of the blood count for the baby at birth and within 5 days, newborns have to be treated if the platelet count is less than 20×10(9)/L.

[Acute airway obstruction mimicking angioedema and revealing spontaneous compressive haematoma of thyroid goitre]. / Détresse respiratoire secondaire à un hématome spontané compressif sur goitre rétrosternal, initialement considérée comme un angiœdème.

Substernal thyroid goitre is the most common cause of superior mediastinal masses. Respiratory symptoms are commonly present, in up to 90% of reported cases. However, these symptoms are rarely acute and life threatening. We report a case of acute airway obstruction, initially misdiagnosed as angioedema, revealing a spontaneous compressive substernal goitre haematoma, in a patient under anticoagulant. This life-threatening complication in patients with goitre and anticoagulant should be known.