Pregnancies Complicated by Severe Autoimmune Thrombocytopenic Purpura

Objectives: To assess pregnancy course and perinatal bleeding in women with severe autoimmune thrombocytopenic purpura. Material and methods: We collected data of 38 pregnancies in 24 women, who were on treatment for autoimmune thrombocytopenic purpura early in pregnancy. Indication for treatment was platelets count 50.000/mm3 or less. We looked for premature rupture of membranes, premature delivery, intrauterine growth restriction and significant blood loss at delivery. Those women were the study group, (group 1). The same variables were looked for in 100 healthy pregnancies taken as control (group 2). Data was compared between the two groups. Information was obtained prospectively from the woman’s follow up visits at maternal medicine clinic, King Hussein Medical Center as well as data gathered from women with previous pregnancies complicated by autoimmune thrombocytopenia. Women who had thrombocytopenia secondary to other conditions such as systemic lupus, bone marrow diseases and other causes, were not included in the study. Results: The study group 1 had nine premature ruptures of membranes in 38 pregnancies, whereas only ten women ruptured their membranes out of 100 in control group 2 with an odds ratio 2.9. Four women had significant blood loss at delivery in group 1 and eight women in group 2 which presents marginal increase for group 1 (odds ratio 1.3). No increase in growth restricted babies nor in premature delivery was noticed. Conclusion: Pregnant women with autoimmune thrombocytopenic purpura on treatment, have significant higher risk to rupture their membranes prematurely. No increase in growth restricted babies and premature deliveries. With good care they can deliver safely with minimum hazard of bleeding.