Management of PV in Pregnancy
To decrease the thrombohemorrhagic complications the Hct should be maintained below 0.45, by phlebotomy if possible. Close monitoring of the Hct and platelet count should be performed on a monthly basis. Low-dose aspirin (75 mg) appears to improve the outcome for pregnant patients with ET133,134 and should also be given in PV. Cytoreductive agents should be avoided if possible, especially in the first trimester, but if cytore-duction is essential interferon-alpha is the drug of choice. Around 20 percent of all pregnancies result in a cesarean section and both morbidity and mortality are increased in patients with PV who undergo other forms of sugery with an uncontrolled Hct. Control of the Hct prior to surgical delivery is therefore important.
For patients with previous fetal loss or those at high risk of thrombosis, low-molecular weight heparin has been reported to be useful in patients with ET.135 Anticoagulation should be continued for 6 weeks postpartum and it is important to watch for rebound increases in the Hct and platelet count in this period.