ITP in pregnancy

Fetal thrombocytopenia may occur due to placental transfer of IgG antiplatelet antibodies in a pregnant woman with ITP. Risk of intracranial haemorrhage in fetus during delivery is low although thrombocytopenia <50 x 109/L may occur in the fetus in up to 30% of pregnancies in women with previously diagnosed ITP. No good predictor for fetal thrombocytopenia. Differential diagnosis: gestational thrombocytopenia (common); count rarely <70 x 109/L. Neonatal count normal. Other causes include pre-eclampsia. Treatment with prednisolone, or IVIg should be administered to the mother with thrombocytopenia severe enough to constitute a haemorrhagic risk to her. Avoid splenectomy—high rate of fetal loss. Severe maternal haemorrhage at delivery is rare but may require platelet transfusion, IVIg and possibly splenectomy. Special antenatal treatment of the fetus is unnecessary but avoid prolonged and complicated labour. Ensure paediatric support at delivery and check neonatal platelet count -monitor for several days (delayed thrombocytopenia). IVIg, prednisolone 392 or exchange transfusion may be required.

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