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Objective To describe the outcome of pregnancies with fetal and neonatal alloimmune thrombocytopenia (FNAIT) in relation to the invasiveness of the management protocol. Design Retrospective analysis of prospectively collected data from a national cohort. Setting Leiden University Medical Centre, the national centre for management of severe red cell and platelet alloimmunisation in pregnancy. Population Ninety-eight pregnancies in 85 women with FNAIT having a previous child with thrombocytopenia with ( n= 16) or without ( n= 82) an intracranial haemorrhage (ICH). Methods Our management protocol evolved over time from (1) serial fetal blood samplings (FBS) and platelet transfusion ( n= 13) via (2) combined FBS with maternal intravenous immunoglobulins ( n= 33) to (3) completely noninvasive treatment with immunoglobulins only ( n= 52 pregnancies, resulting in 53 neonates). Perinatal outcome was assessed according to the three types of management. Main outcome measures Occurrence of ICH, perinatal survival, gestational age at birth and complications of FBS. Results All but one of 98 pregnancies ended in a live birth; none of the neonates had an ICH. The median gestational age at birth was 37 weeks (range 32–40). In groups 1 and 2, three emergency caesarean sections were performed after complicated FBS, resulting in two healthy babies and one neonatal death. Conclusion Noninvasive antenatal management of pregnancies complicated by FNAIT appears to be both effective and safe. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the safety of vaginal delivery in pregnancies with fetal and neonatal alloimmune thrombocytopenia (FNAIT). Design Prospective data collection. Setting Leiden University Medical Centre, the national centre for management of severe red cell and platelet alloimmunisation. Population Thirty-two pregnancies with FNAIT, with a sibling with thrombocytopenia but without an intracranial haemorrhage (ICH). Methods The mode of delivery, platelet count in cord blood and neonatal outcome were analysed. All women received weekly intravenous immunoglobulin from 32 to 38 weeks of gestation. Head ultrasound scan was performed in all neonates. Main outcome measures Signs of ICH or other bleeding in the neonates. Results Twenty-three women delivered vaginally. Nine caesarean sections were performed, all for obstetric reasons. Median platelet count at birth was 142 × 109/l (range, 4–252 × 109/l), with severe thrombocytopenia (<50 ×109/l) in four neonates, of which three were born vaginally. None of the neonates showed signs of ICH or other bleeding. Conclusions In pregnancies with FNAIT and a thrombocytopenic sibling without ICH, vaginal delivery was not associated with neonatal intracranial bleeding. These initial results support our noninvasive management of these pregnancies with FNAIT. [ABSTRACT FROM AUTHOR]