Clinical Features of Pregnancy and Delivery in Patients with Idiopathic Thrombocytopenic Purpura

Moon Ju Jang; Yun Ho Bae; So Yeon Oh; So Young Chong; Seung Ju Shin; Sung Woon Chang; Doyeun Oh

doi:10.5045/kjh.2006.41.4.266

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Jang, Bae, Oh, Chong, Shin, Chang, and Oh: Clinical Features of Pregnancy and Delivery in Patients with Idiopathic Thrombocytopenic Purpura

Original Article

Korean J Hematol 2006;41(4):266-271.

Published online: 19 January 2006

DOI: https://doi.org/10.5045/kjh.2006.41.4.266

Clinical Features of Pregnancy and Delivery in Patients with Idiopathic Thrombocytopenic Purpura

Moon Ju Jang, M.D., Yun Ho Bae, M.D., So Yeon Oh, M.D., So Young Chong, M.D., Seung Ju Shin, M.D.¹, Sung Woon Chang, M.D.¹, Doyeun Oh, M.D.

Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea

¹Department of Internal Medicine, Obstetric and Gynecology, Bundang CHA Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea

Correspondence to：Doyeun Oh, M.D. Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, Pochon CHA University 351, Yatap-dong, Bundang-gu, Sungnam 463-712, Korea Tel: +82-31-780-5217, Fax: +82-31-780-5219 E-mail: doh@cha.ac.kr

Received 10 November 2005 Revised 4 November 2006 Accepted 9 November 2006

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

Patients with the condition of idiopathic thrombocytopenic purpura (ITP) may present with, maternal and fetal hemorrhagic complications. Appropriate monitoring and treatment may be important in obstetric management.

Methods:

A retrospective chart review was performed for obstetric patients with ITP at Bundang CHA hospital from March 1996 to March 2005.

Results:

Nineteen women with ITP delivered 22 children in 22 pregnancies. The median age at delivery was 30 years (range, 21～37 years). The median platelet counts before pregnancy, during pregnancy, and at delivery were 44,000/μL (range, 20,000～225,000/μL), 40,500/μL (range, 13,000～335,000/μL), and 73,500/μL (range, 40,000～308,000/μL. Treatment for ITP was done in 14 cases (63.6%) during pregnancy and in 18 cases (81.8%) at delivery. Platelet transfusion was done for one case during pregnancy but, was performed in 17 cases (77.3%) at delivery. Vaginal delivery was done in 10 cases (45%) and a Cesarean section was done in 12 cases (55%). No obstetric complications were observed. The median platelet count of 17 infants was 220,000/μL (range, 59,000～315,000/μL). Four neonates were born with platelet counts below 150,000/μL. No infant showed any clinical signs of hemorrhage and there were not any neonatal complications.

Conclusion:

In our study, obstetric patients with ITP and their neonates were safe with no hemorrhagic complication. However, when compared to the current guidelines, the treatment strategy used in the present study was excessive. Appropriate treatment according to the guidelines is necessary during the obstetric management of patients with ITP.

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Keywords: Idiopathic thrombocytopenic purpura, Pregnancy, Thrombocytopenia

REFERENCES

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Fig. 1

Relationship between the maternal platelet count during pregnancy and neonatal platelet count.

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Table 1.

Clinical characteristics of patients

Median gestational age at delivery	38 weeks (range, 33～41)
Median age at delivery	30 years (range, 21～37)
	Number (%)
Delivery history	n=22
Initial event	7 (32)
Once	12 (54)
Twice	3 (14)
Date of diagnosis of ITP	n=19
Before pregnancy	9 (47.4)
During pregnancy	10 (52.6)
Symptoms of bleeding	n=22
No symptom	12 (54.5)
Purpura of easy bruising	10 (45.5)
Bleeding	0 (0)
Type of delivery	n=22
Vaginal delivery	10 (45.5)
Cesarean section	12 (54.5)

Table 2.

Platelet count before pregnancy, during preg nancy, and at delivery

Time	Number of patient	Platelet count median (range)
Before pregnancy	9	44,000 (20,000～225,000)/μL
During pregnancy	20	40,500 (13,000～335,000)/μL
At delivery	22	73,500 (40,000～308,000)/μL

Table 3.

Treatment option of obstetric patients with ITP

Treatment	During pregnancy number (%)	At delivery number (%)
Total	14 (63.6)	18 (81.8)
Corticosteroids	13 (59.1)	10 (45.5)
IVIG	3 (13.6)	6 (27.2)
Platelet transfusion	1 (4.5)	17 (77.3)
Corticosteroids, IVIG	3 (13.6)	0 (0)
Corticosteroids, platelet transfusion	0 (0)	5 (22.7)
IVIG, platelet transfusion	0 (0)	2 (9.1)
Corticosteroids, IVIG, platelet transfusion	0 (0)	4 (18.2)

Abbreviations: IVIG, intravenous immunoglobulin.

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