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Korean Journal of Obstetrics & Gynecology 2004;47(4):605-611.
Published online April 1, 2004.
The Clinical Features of Idiopathic Thrombocytopenic Purpura in Pregnancy and Prediction of Neonatal Thrombocytopenia.
Eun Jeong Chung, Joon Cheol Park, Jeong Ho Rhee, Jong In Kim
Department of Obstetric and Gynecology, Keimyung University School of Medicine, Korea.
Abstract
OBJECTIVE
The aim of this study was to expect the possibility of developing fetal thrombocytopenia by observation of the clinical features of pregnant women with ITP and their neonates, and to know the effect of steroid and IVIG therapy. METHODS: The patient group was 21 cases of pregnancies with ITP diagnosed by Bone marrow biopsy or suspective to have ITP due to thrombocytopenia (150 K/micro L) not complicated by sepsis, preeclampsia or massive bleeding resulting DIC, who were admitted and delivered at Dongsan Medical Center, Keimyung University from Jul. 1998 to Jun. 2002. The study was performed retrospectively. We defined severe thrombocytopenia as less than 70 K/micro L and treated them with Prednisolone or IVIG during pregnancy and Platelet concentrate in some perinatal condition. On admission, we performed a history taking about splenectomy etc., antiplatelet antibody test and serial follow up of CBC, coagulation test during perinatal period. We used Fisher's exact test to detect statistical significance between clinical features of pregnancy women with ITP and severe neonatal thrombocytopenia and concluded to be significant if p-value was less than 0.05. RESULTS: The delivery mode of pregnancies with ITP was Cesarean section for 9 cases and vaginal delivery for 12 cases. The decision was purely dependant on obstetric indication. Because there was no significant bleeding during prenatal period even among the women with severe thrombocytopenia, they were treated with steroid in 8 cases followed by IVIG in 1 case, only IVIG in 1 case under no transfusion of Platelet concentrate. Platelet count was not normalized completely but increased over 100% in 7 cases and there was no response in only 1 case. Soon after delivery, neonatal thrombocytopenia was seen in 2 cases (9.5%). There was no ecchimosis or intracranial hemorrhage in spite of vaginal delivery in both cases. CONCLUSION: There were no prospective factors to predict the relationship between the clinical features of pregnant women with ITP and fetal thrombocytopenia. Most of the cases in which steroid therapy was done did not show neonatal thrombocytopenia but there was no statistical significance. There needs to be further study with much more cases.
Key Words: Idiopathic thrombocytopenic purpura, Steroid, IVIG


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