Maternal and neonatal outcomes of the pregnant women with idiopathic thrombocytopenic purpura

Abstract

Objective: In this study, we aimed to report the maternal and neonatal outcomes of the pregnant women with idiopathic thrombocytopenic purpura (ITP) whose gestational follow-up and delivery were carried out in our clinic. Methods: In our study, the files of newborns and pregnant women with ITP whose gestational follow-up and delivery were carried out in the Department of Obstetrics and Gynecology, Faculty of Medicine, ‹nönü University between January 1, 2010 and January 1, 2017 were reviewed prospectively and the cases matching with the inclusion criteria were included in the study. Results: During the study period, it was found that 12 (17.6%) of 68 patients followed up for ITP diagnosis were established with the diagnosis during pregnancy while 56 (82.4%) of them were established with the ITP diagnosis before the pregnancy. The use of steroids was found at a higher level, which was statistically significant, in patients whose platelet count was below 50×109 /l during delivery compared to those whose platelet count was above 50×109 /l (p=0.003). The history of splenectomy during pregestational period was observed in 13 (29.5%) patients in the pregnant women with ITP whose platelet count was >50×109 /l and in 1 (4.2%) patients in the pregnant women whose platelet count was <50×109 /l (p=0.013). In terms of newborn intense care need and newborn treatment need, there was no significant difference between the patient group whose delivery type was cesarean section and the patient group whose delivery type was vaginal delivery (p=0.889 and p=0.598, respectively). While postpartum hemorrhage was observed in 6 (8.8%) patients, 17 (25%) patients received thrombocytapheresis treatment, 5 (7.3%) patients received intravenous immunoglobulin (IVIG) treatment, and 8 (13.2%) patients received thrombocytapheresis treatment together with IVIG. No significant correlation was found between maternal platelet count during delivery and newborn platelet count during delivery (p=0.625; r=0.06). Conclusion: Maternal and neonatal prognosis of pregnant women with ITP is usually good. Maternal platelet count below 50×109 /l during pregnancy is associated with more medical treatment needs during pregnancy and more blood product needs during delivery, yet the delivery type has no impact on perinatal outcomes / Öz: Amaç: Bu çalışmada kliniğimizde gebelik takibi ve doğumu gerçekleştirilen idiyopatik trombositopenik prupura (ITP) tanısı almış gebelerin maternal ve neonatal sonuçlarını ortaya koymayı amaçladık. Yöntem: Çalışmamızda inönü Üniversitesi Tıp Fakültesi Hastanesi Kadın Hastalıkları ve Doğum Kliniği’nde, 01.01.2010 – 01.01.2017 tarihleri arasında gebelik takibi ve doğumu gerçekleştirilen idiyopatik trombositopenik purpural› gebelerin ve yenidoğanların dosyalar› retrospektif olarak taranarak, çal›flma kriterlerine uygun hastalar çal›flmaya dahil edildi. Bulgular: Çalşma periyodu boyunca ITP tan›s› ile izlenen 68 hastadan 12’sinin (%17.6) gebelik s›ras›nda, 56’s›n›n (%82.4) ise gebelik öncesi ITP tan›s› ald›ğ› saptand›. Do¤um s›ras›nda trombosit say›s› 50×109/l’nin alt›nda olan hastalarda steroid kullan›m›, trombosit say›s› 50×109/l’nin üstünde olan hastalara göre istatistiksel olarak anlaml› düzeyde yüksek bulundu (p=0.003).Trombosit say›s› >50×109 /l olan ITP’li gebe grubunda 13 (%29.5) hastada, trombosit say›s› <50×109 /l olan gebe grubunda ise 1 (%4.2) hastada gebelik öncesinde splenektomi operasyonu geçirme öyküsü izlendi (p=0.013). Doğum flekli sezaryen olan hasta grubu ile vajinal doğum olan hasta grubu aras›nda yenidoğan yoğun bak›m ihtiyac› ve yenidoğan tedavi gereksinimi aç›s›ndan anlamlı fark izlenmedi (s›ras›yla p=0.889 ve p=0.598). Doğum s›ras›nda 6 (%8.8) hastada postpartum kanama gözlenirken, 17 (%25) hastada trombosit aferez, 5 (%7.3) hastada intravenöz immunglobulin (IVIG), 8 (%13.2) hastada ise trombosit aferez ile birlikte IVIG tedavisi kullan›ld›. Doğumda maternal trombosit say›s› ile doğumda yenido¤an trombosit say›s› aras›nda anlaml› ilişki saptanmad› (p=0.625; r=0.06). Sonuç: ITP’li gebelerin maternal ve neonatal prognozu genellikle iyidir. Gebelik sırasında maternal trombosit sayısının <50×109 /l olması gebelik sırasında daha fazla medikal tedavi gereksinimi vedoğum sırasında daha fazla kan ürünü ihtiyac› ile ilişkili olup doğum fleklinin perinatal sonuçlar üzerine etkisi görünmemektedir.