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Severe Primary Autoimmune Thrombocytopenia (ITP) in Pregnancy: a National Cohort Study.

Severe Primary Autoimmune Thrombocytopenia (ITP) in Pregnancy: a National Cohort Study.
Author Information (click to view)

Care A, Pavord S, Knight M, Alfirevic Z,


Care A, Pavord S, Knight M, Alfirevic Z, (click to view)

Care A, Pavord S, Knight M, Alfirevic Z,

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BJOG : an international journal of obstetrics and gynaecology 2017 04 22() doi 10.1111/1471-0528.14697
Abstract
OBJECTIVE
To quantify UK incidence of severe ITP in pregnancy, determine current treatment strategies and establish maternal and neonatal morbidity and mortality associated with severe ITP in pregnancy.

DESIGN
A prospective national cohort study SETTING: United Kingdom POPULATION: Women with severe ITP; defined as platelets <50 x 10(9) /l in pregnancy or antenatal treatment of isolated low platelets. METHODS
Data collected via United Kingdom Obstetric Surveillance System (UKOSS) between 1(st) June 2013-31(st) January 2015 from all UK Consultant led obstetric units.

MAIN OUTCOME MEASURE
Incidence of Severe ITP in pregnancy.

RESULTS
The estimated incidence of severe ITP in pregnancy is 0.83 per 10,000 maternities (95% CI 0.68-1.00). 22 pregnant women (21%) did not receive any antenatal therapy, 85 (79%) had therapy. There was no difference between asymptomatic treated and untreated cohorts in severity of disease or outcome. Postpartum haemorrhage (51%) and severe postpartum haemorrhage (21%) was reported more frequently than the reported rate in the general pregnant population (5-10%). No neonates required treatment for thrombocytopenia and there were no cases of neonatal intracranial bleeding.

CONCLUSIONS
Current UK management of severe ITP in pregnancy results in an exceptionally low morbidity and mortality for the neonate. Mothers with ITP remain at increased risk of severe post-partum haemorrhage and should be delivered at units that have the capacity to manage severe PPH effectively. Whilst balancing risks for pregnancy of prophylactic antenatal treatment in asymptomatic women against observed low disease morbidity, we may be over treating asymptomatic patients. This article is protected by copyright. All rights reserved.

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