Search

We report a patient who had a marked exacerbation of idiopathic thrombocytopenic purpura at 33 weeks of pregnancy. The platelet count rose in response to treatment with high doses of glucocorticoids and it was possible to allow the pregnancy to continue until 39 weeks. The patient was then delivered by elective Caesarean section and she had a splenectomy at the same time. A transfusion of platelets was administered as soon as the splenic vessels had been clamped. The resultant excess of platelets necessitated treatment with acetylsalicylic acid. At 18 months after Caesarean section and splenectomy the thrombocytopenia had not recurred. The infant had transient neonatal thrombocytopenia but required no active treatment for this.

In pregnancy and neonatal period both mother and child are endangered by bleeding complications due to maternal idiopathic thrombocytopenic purpura. Obstetrical and perinatal management therefore must aim at increasing maternal and fetal platelet count. In our paper six patients in nine pregnancies are reported. Two of them (five pregnancies) were treated with corticosteroids, four of the patients were successfully treated with i.v. immunoglobulins (IgG). Longterm steroid application and splenectomy during pregnancy may be hazardous for mother and fetus. IgG i.v. administration in contrast offers a new and safe way to control maternal and fetal platelet counts during pregnancy, delivery and the neonatal period.

ITP in pregnancy may lead to fetal thrombocytopenia caused by the transplacental passage of maternal antiplatelet antibody. The most hazardous complication in the infant is intracranial hemorrhage. In addition ITP in pregnancy is reported to be associated with an increased abortion rate and an elevated fetal morbidity and mortality. Therefore obstetric management must aim at increasing maternal and fetal platelets. Several therapeutic approaches to the treatment of ITP in pregnancy are evaluated. Two cases of ITP in pregnancy are reported. Administration of high-dose intravenous immunoglobulin is introduced as a new therapy for ITP in pregnancy. The rapid reversal of thrombocytopenia following immunoglobulin G administration suggests that it is useful especially as emergency treatment for ITP in pregnancy.

Glanzmann's thrombasthenia is a rare, autosomal recessive disorder of bleeding arrest. The differential diagnosis of this platelet defect with respect to recently gained knowledge is presented in the case of a pregnant woman. Because of pelvic presentation a cesarean section was performed after adequate platelet substitution, which did not involve excessive blood loss. A severe puerperal infection necessitated an abdominal hysterectomy after appropriate platelet transfusion. The difficulties in testing platelet function in the newborn are discussed. The effectiveness of a commercially available homologous phospholipide complex (Fibraccel) was tested on the patient in a noncritical phase. The results appear important for general procedure when pregnancy and platelet dysfunction concur.