5 Yearsʼ Experience of a Tertiary Center with Thrombocytopenic Pregnancies: Gestational Thrombocytopenia, Idiopathic Thrombocytopenic Purpura and Hypertensive Disorders of Pregnancy

Abstract

Aim To evaluate thrombocytopenic pregnancies including gestational thrombocytopenia (GT), idiopathic thrombocytopenic purpura (ITP), and hypertensive disorders of pregnancy (HDP).

Materials and Methods We evaluated the pregnancy outcomes and laboratory findings of 385 patients diagnosed with GT, ITP, or HDP whose thrombocyte levels were < 150 000/µL.

Results GT, ITP, and HDP were the final diagnoses in 315 (81.8%), 35 (9.1%), and 35 (9.1%) cases, respectively. Patients diagnosed during the 1st trimester and diagnosed with ITP had significantly lower minimal platelet counts during the antenatal period and prior to delivery (p < 0.001; p < 0.001; p < 0.001; p < 0.001). Transfusion of any kind of blood product was given in 9.9% (n = 38) of all cases. Twelve patients had methylprednisolone and/or intravenous immunoglobulin treatments during the antenatal period. All patients who had undergone medical treatment were also found to have ITP. Four out of 385 patients underwent hysterectomy post partum due to refractory hemorrhage. Analysis of newborn platelet levels showed no statistical differences between any of the groups. Despite the lack of statistical significance, the rate of thrombocytopenia in newborns was 50% in patients with severe thrombocytopenia, while rates were 25.6 and 18.1% in patients with moderate and mild thrombocytopenia, respectively.

Conclusion Thrombocytopenic pregnancies must be carefully evaluated with regard to the severity of thrombocytopenia, gestational period at initial diagnosis, and etiology. In particular, patients with ITP must be evaluated carefully as these patients are more likely to require transfusions and have platelet counts < 50 × 10³/µl.

Zusammenfassung

Zielsetzung Ziel war es, thrombozytopenische Erkrankungen in der Schwangerschaft wie beispielsweise die schwangerschaftsassoziierte Thrombozytopenie (GT), idiopathische thrombozytopenische Purpura (ITP) sowie hypertensive Schwangerschaftserkrankungen (HDP) zu untersuchen.

Material und Methoden Das Schwangerschafts-Outcome und die Laborbefunde von 385 Patientinnen mit GT, ITP oder HDP und einem Thrombozytenwert von < 150 000/µL wurden evaluiert.

Ergebnisse GT, ITP bzw. HDP wurde jeweils bei 315 (81,8%), 35 (9,1%) bzw. 35 (9.1%) Patientinnen diagnostiziert. Patientinnen, die bereits im 1. Trimenon mit ITP diagnostiziert wurden, hatten pränatal sowie unmittelbar vor der Entbindung einen signifikant niedrigeren minimalen Thrombozytenspiegel (p < 0,001; p < 0,001; p < 0,001; p < 0,001). 9,9% (n = 38) aller Fälle benötigten eine Transfusion von Blutprodukten. Zwölf Patientinnen erhielten Methylprednisolon in der pränatalen Phase und/oder eine intravenöse Behandlung mit Immunoglobulin. Alle Patientinnen, die medikamentös behandelt wurden, wurden mit ITP diagnostiziert. Vier von 385 Patientinnen mussten sich wegen hartnäckiger Blutungen postpartal einer Hysterektomie unterziehen. Eine Analyse der neonatalen Thromobzytenwerte ergab statistisch keine signifikanten Unterschiede zwischen den Gruppen. Obwohl die Grenze zur statistischen Signifikanz nicht erreicht wurde, hatten 50% der Kinder, deren Mütter an schwerer Thrombozytopenie litten, eine Thrombozytopenie. Dagegen litten 25,6 bzw 18,1% der Neugeborenen von Müttern mit mittlerer bzw. milder Thrombozytopenie an einer Thrombozytopenie.

Schlussfolgerung Thrombozytopenische Schwangerschaften müssen im Hinblick auf die Schwere der Thrombozytopenie, das Gestationsalter bei der Erstdiagnose und die Ätiologie sorgfältig evaluiert werden. Patientinnen mit ITP bedürfen einer besonders sorgfältigen Evaluierung, da die Wahrscheinlichkeit höher ist, dass sie eine Transfusion benötigen werden und dass ihre Thrombozytenwerte < 50 × 10³/µl betragen.

Key words

pregnancy - gestational thrombocytopenia - idiopathic thrombocytopenic purpura - hypertensive disorders of pregnancy

Schlüsselwörter

Schwangerschaft - schwangerschaftsassoziierte Thrombozytopenie - idiopathische thrombozytopenische purpura - hypertensive Schwangerschaftserkrankungen

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