Management of immune thrombocytopenia purpura at a military medical center.

OBJECTIVE

To investigate whether fetal platelets in immune thrombocytopenia purpura (ITP) may be predicted by antepartum assessment.

METHODS

A prospective analysis was conducted of 28 pregnant women with ITP out of 8,056 deliveries. Of the 28 patients, 13 were evaluted by fetal scalp sampling and 11 were evaluated by percutaneous umbilical blood sampling (PUBS).

RESULTS

The mean fetal and maternal platelet counts prior to delivery were 146,000 and 176,000, respectively. The mean fetal and maternal platelet counts after delivery were 245,000 and 149,000, respectively. Fetal cord platelet counts could not be predicted by maternal platelet count, the presence/absence of maternal direct/indirect anti-platelet antibodies, steroid therapy, or history of splenectomy. PUBS for fetal platelet assessment correlated well with fetal postdelivery counts.

CONCLUSIONS

Patients with ITP rarely exhibit complications. No antepartum characteristic enhances reliable prediction of neonatal outcome. Method of delivery should be based on obstetric guidelines.