Waghmare Bhavana V, Jajoo Shubhada
Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND.
Cureus. 2024 Aug 20;16(8):e67284. doi: 10.7759/cureus.67284. eCollection 2024 Aug.
Primary immune thrombocytopenia (ITP) is an autoimmune disorder characterized by a low platelet count due to the immune system's destruction of its platelets. During pregnancy, ITP poses significant challenges due to the need to balance maternal and fetal health. This comprehensive review aims to explore the pathophysiology, diagnostic approaches, and management strategies for ITP in pregnant women and discuss emerging treatments and future research directions. A thorough examination of current literature was conducted, including studies on the epidemiology, pathophysiology, diagnostic criteria, and treatment options for ITP in pregnancy. Relevant guidelines and expert consensus were also reviewed to provide a comprehensive understanding of best practices for managing this condition. The management of ITP in pregnancy requires a multidisciplinary approach and individualized treatment plans. First-line therapies include corticosteroids and intravenous immunoglobulin (IVIG), with second-line options such as thrombopoietin receptor agonists and immunosuppressive agents reserved for refractory cases. The choice of treatment depends on the severity of thrombocytopenia, the presence of bleeding symptoms, and gestational age. Special considerations include the risk of neonatal thrombocytopenia and the need for careful monitoring during labor and delivery. Emerging therapies and novel research offer promising advancements, though further studies are needed to validate their safety and efficacy. ITP in pregnancy is a complex condition that necessitates a careful balance between treating the mother and protecting the fetus. The management strategies must be tailored to each patient's needs, minimizing risks and optimizing outcomes. Continued research into the underlying mechanisms and treatment options will be crucial to improving care for pregnant women with ITP. This review provides a detailed synthesis of current knowledge and offers practical guidance for healthcare providers managing ITP during pregnancy.
原发性免疫性血小板减少症(ITP)是一种自身免疫性疾病,其特征是由于免疫系统破坏血小板导致血小板计数降低。在怀孕期间,由于需要平衡母体和胎儿的健康,ITP带来了重大挑战。这篇综述旨在探讨孕妇ITP的病理生理学、诊断方法和管理策略,并讨论新兴治疗方法和未来研究方向。对当前文献进行了全面审查,包括关于ITP在妊娠中的流行病学、病理生理学、诊断标准和治疗选择的研究。还审查了相关指南和专家共识,以全面了解管理这种疾病的最佳实践。妊娠ITP的管理需要多学科方法和个体化治疗方案。一线治疗包括皮质类固醇和静脉注射免疫球蛋白(IVIG),二线选择如血小板生成素受体激动剂和免疫抑制剂则用于难治性病例。治疗方法的选择取决于血小板减少症的严重程度、出血症状的存在以及孕周。特殊考虑因素包括新生儿血小板减少症的风险以及分娩期间仔细监测的必要性。新兴疗法和新研究提供了有希望的进展,不过还需要进一步研究来验证其安全性和有效性。妊娠ITP是一种复杂的疾病,需要在治疗母亲和保护胎儿之间仔细权衡。管理策略必须根据每个患者的需求进行调整,将风险降至最低并优化治疗结果。对潜在机制和治疗选择的持续研究对于改善ITP孕妇的护理至关重要。本综述详细综合了当前知识,并为孕期管理ITP的医疗保健提供者提供了实用指导。