IDIOPATHIC TROMBOCYTOPENIC PURPURA DURING PREGNANCY.OBSTETRICS AND PERENATAL RISKS

V. B. Tskhay; E. K. Grebennikova

doi:10.17749/2070-4968.2015.9.2.072-079

IDIOPATHIC TROMBOCYTOPENIC PURPURA DURING PREGNANCY.OBSTETRICS AND PERENATAL RISKS

V. B. Tskhay, E. K. Grebennikova

https://doi.org/10.17749/2070-4968.2015.9.2.072-079

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Abstract

Idiopathic thrombocytopenic purpura is a relatively rare disease, especially during pregnancy. Currently, there are many ways of diagnostics, monitoring and treatment of patients. Pregnant women with idiopathic thrombocytopenic purpura are at risk of hemorrhagic complications during pregnancy and postpartum period; moreover, they may give birth to infants with severe thrombocytopenia. Specialists widely discuss obstetric and perinatal risks in this disease, the risk of ante- and intranatal intracranial hemorrhage in newborns. In this review we have assessed the risks of obstetric and perinatal outcomes with different methods of delivery as well as the effectiveness of therapeutic interventions in pregnant women with idiopathic thrombocytopenic purpura.

Keywords

Immune thrombocytopenic purpura, pregnancy, neonatal thrombocytpenia, intracranial hemorrhage.

About the Authors

V. B. Tskhay

Krasnoyarsk state medical university
Russian Federation
MD, professor, head of Department perinatology, obstetrics and gynecology

E. K. Grebennikova

Krasnoyarsk state medical university
Russian Federation
PhD, Assistant of Department perinatology, obstetrics and gynecology

References

1. Vasil'ev S.A., Vinogradov V.L., Mazurov A.V., Markova M.L. Akusherstvo, ginekologiya i reproduktsiya/Obstetrics, gynecology and reproduction. 2014; 2: 112-125. In Russian.

2. Dadak K., Makatsariya A.D., Blinov D.V., Zimovina U.V. Akusherstvo, ginekologiya i reproduktsiya/Obstetrics, gynecology and reproduction. 2014; 2: 69-78. In Russian.

3. Krasnova N.Ju. Optimization tactics of pregnancy in women with idiopathic thrombocytopenic purpura. Phd. Diss. [Optimizacija taktiki vedenija beremennosti u zhenshhin s idiopaticheskoj trombocitopenicheskoj purpuroj: avtoref. dis. … kand. med. nauk. In Russian]. Moscow. 2007; 24 s.

4. Makacarija A.D., Bicadze V.O., Akin’shina S.V. Thrombosis and thromboembolism in obstetric practice: Molecular genetic mechanisms and strategy for the prevention of thromboembolic complications. A Guide for Physicians [Trombozy i trombojembolii v akusherskoginekologicheskoj praktike: Molekuljarnogeneticheskie mehanizmy i strategija profilaktiki trombojembolicheskih oslozhnenij. Rukovodstvo dlja vrachej. In Russian]. Moscow. 2007; 1064 s.

5. Savchenko E.A., Grinshtejn I.Ju., Savchenko A.A., Grinshtejn Ju.I., Govorin A.V. Sibirskoe medicinskoe obozrenie. 2009; 3: 45-49. In Russian.

6. Sokolova M.Ju. Pregnancy and childbirth in women with idiopathic thrombocytopenic purpura [Beremennost’ i rody u zhenshhin s idiopaticheskoj trombocitopenicheskoj purpuroj: avtoref. dis. … dokt. med. nauk. In Russian]. Moscow. 2004; 50 s. 7. Shevchenko Ju.N., Savchenko A.A., Grican G.V. Sibirskoe medicinskoe obozrenie. 2009; 4 (58): 38-40. In Russian.

7. Andersson P.O., Olsson A., Wadenvik H. Reduced transforming growth factor-beta1 production by mononuclear cells from patients with active chronic idiopathic thrombocytopenic purpura. Br. J. Haematol. 2002 Mar; 116 (4): 862-7.9. Borna S., Borna H., Khazardoost S. Maternal and neonatal outcomes in pregnant women with immune thrombocytopenic purpura. Arch Iran Med. 2006 Apr; 9 (2): 115-8.

8. Brychtová P., Procházka M., Lattová V., Lubušký M., Procházková J., Slavík L., Úlehlová J., Simetka O. Occurence, etiology and clinical significance of trombocytopenia in pregnancy. Ceska Gynekol. 2013 Dec; 78 (6): 560-5.

9. Burrows R.F., Kelton J.G. Low fetal risks in pregnancies idiopathic associated with thrombocytopenic purpura. Am. J. Obstet. Gynecol. 1990 Oct; 163 (4 Pt 1): 1147-50.

10. Burrows R.F., Kelton J.G. Pregnancy in patient s with idiopathic thrombocytopenic purpura: as sessing the risks for the infant at delivery. Obstet Gynecol. Surv. 1993 Dec; 48 (12): 781-8.

11. Christova R., Lisichkov T., Chernev T. Autoimmune thrombocitopenic purpura in pregnancy. Akush. Ginekol. (Sofiia). 2009; 48 (6): 42-6.

12. Cines DB, McMillan R. Management of adult idiopathic thrombocytopenic purpura. Annu Rev. Med. 2005; 56: 425-42.

13. Cromwell C., Tarantino M., Aledort L.M. Safety of anti-D during pregnancy. Am. J. Hematol. 2009 Apr; 84 (4): 261-2.

14. Diagnosis and treatment of idiopathic thrombocytopenic purpura: Recommendations of the American Society of Hematology. Ann. Intern. Med. 1997; 126: 319-326.

15. Decroocq J., Ma rcellin L., Le Ray C., Willems L. Rescue therapy with romiplostim for refractory primary immune thrombocytopenia during pregnancy. Obstet. Gynecol. 2014 Aug; 124 (2 Pt 2 Suppl 1): 481-3.

16. Faridi A., Rath W. Differential diagnosis of thrombocytopenia in pregnancy. Zentralbl. Gynakol. 2001 Feb; 123 (2): 80-90.

17. Federici L., Serraj K., Maloisel F., Andrès E. Thrombocytopenia during pregnancy: from etiologic diagnosis to therapeutic management. Press. Med. 2008 Sep; 37 (9): 1299-307.

18. Garmel S.H., Craigo S.D., Morin L.M., Crowley J.M., D’Alton M.E. The role of percutaneous umbilical blood sampling in the management of immune thrombocytopenic purpura. Prenat Diagn. 1995 May; 15 (5): 439-45.

19. Gernsheimer T., McCrae K.R. Immune thrombocytopenic purpura in pregnancy. Curr. Opin. Hematol. 2007 Sep; 14 (5): 574-80.

20. Gill K.K., Kelton J.G. Management of idiopathic thrombocytopenic purpura in pregnancy. Semin Hematol. 2000 Jul; 37 (3): 275-89.

21. Hwa H.L., Chen R.J., Chen Y.C., Wang T.R., Huang S.C., Chow S.N. Maternal and fetal outcome of pregnant women with idiopathic thrombocytopenic purpura: retrospective analysis of 25 pregnancies. J. Formos. Med. Assoc. 1993 Nov; 92 (11): 957-61.

22. Itoh H., Sagawa N., Fujii S. Management of pregnant women complicated with idiopathic thrombocytopenic purpura. Nihon. Rinsho. 2003 Apr; 61 (4): 638-43.

23. Kuwana M., Okazaki Y., Kaburaki J., Kawakami Y., Ikeda Y. Spleen is a primary site for activation of platelet-reactive T and B cells in patients with immune thrombocytopenic purpura. J. Immunol. 2002 Apr 1; 168 (7): 3675-82

24. Kuwana M., Ikeda Y. The role of autoreactive T-cells in the pathogenesis of idiopathic thrombocytopenic purpura. Int. J. Hematol. 2005 Feb; 81 (2): 106-12.

25. Martí-Carvajal A.J., Peña-Martí G.E., Comunián-Carrasco G. Medical treatments for idiopathic thrombocytopenic pur pura during pregnancy. Cochrane Database Syst. Rev. 2009 Oct 7; 4: CD007722.

26. McMillan R. Autoantibodies and autoantigens i n chronic immune thrombocytopenic purpura. Semin. Hematol. 2000 Jul; 37 (3): 239-48.

27. McMillan R. The pathogenesis of chronic immune thrombocytopenic purpura. Semin. Hematol. 2007 Oct; 44 (4 Suppl 5): 3-11.

28. Michel M., Novoa M.V., Bussel J.B. Intravenous anti-D as a treatment for immune thrombocytopenic purpura (ITP) during pregnancy. Br. J. Haematol. 2003 Oct; 123 (1): 142-6.

29. Olsson B., Andersson P.O., Jernås M., Jacobsson S., Carlsson B., Carlsson L.M., Wadenvik H. T-cell-mediated cytotoxicity toward platelets in chronic idiopathic thrombocytopenic purpura. Nat. Med. 2003 Sep; 9 (9): 1123-4.

30. Patil A.S., Dotters-Katz S.K., Metjian A.D., James A.H., Swamy G.K. Use of a thrombopoietin mimetic for chronic immune thrombocytopenic purpura in pregnancy. Obstet. Gynecol. 2013 Aug; 122 (2 Pt 2): 483-5.

31. Razafintsalama T., Coiffic J., Godin O., Lassel L., Chevrant-Breton O., Poulain P. Percutaneous umbilical blood sampling in pregnant women with thrombocytopenia. Apropos of 35 cases. J. Gynecol. Obstet. Biol. Reprod. (Paris). 2000 Apr; 29 (2): 176-84.

32. Subbaiah M., Kumar S., Roy K.K., Sharma J.B., Singh N. Pregnancy outcome in patients with idiopathic thrombocytopenic purpura. Arch Gynecol. Obstet. 2014 Feb; 289 (2): 269-73.

33. Suri V., Aggarwal N., Saxena S., Malhotra P., Varma S. Maternal and perinatal outcome in idiopathic thrombocytopenic purpura (ITP) with pregnancy. Acta Obstet Gynecol Scand. 2006; 85 (12): 1430-5.

34. Townsley D.M. Hematologic complications of pregnancy. Semin Hematol. 2013 Jul; 50 (3): 222-31.

35. van der Lugt N.M., van Kampen A., Walther F.J., Brand A., Lopriore E. Outcome and management in neonatal thrombocytopenia due to maternal idiopathic thrombocytopenic p urpura. Vox Sang. 2013 Oct; 105 (3): 236-43.

36. Wang Q., Nie L.L. Clinical analysis of 92 cases of pregnancy with idiopathic thrombocytopeni c purpura. Zhonghua. Fu. Chan. Ke. Za. Zhi. 2004 Nov; (11): 729-32.

37. Yassaee F., Eskandari R., Amiri Z. Pregnancy outcomes in women with idiopathi c thrombocytopenic purpura. Iran. J. Reprod Med. 2012 Sep; 10 (5): 489-92.

38. Young S.K., Al-Mondhiry H.A., Vaida S.J., Ambrose A., Botti J.J. Successful use of argatroban during the third trimester of pregnancy: case report and review of the literature. Pharmacotherapy. 2008 Dec; 28 (12): 1531-6.

For citation:

Tskhay V.B., Grebennikova E.K. IDIOPATHIC TROMBOCYTOPENIC PURPURA DURING PREGNANCY.OBSTETRICS AND PERENATAL RISKS. Obstetrics, Gynecology and Reproduction. 2015;9(2):72-79. (In Russ.) https://doi.org/10.17749/2070-4968.2015.9.2.072-079