[Immune thrombocytopenic purpura and pregnancy: maternal risk factors]

Authors analyse 75 pregnancies and 51 deliveries, respectively, of 45 mothers with chronic immune thrombocytopenia (ITP) from the point of view of maternal risks. Pregnancies that occurred in active disease were electively terminated. It was found that pregnancy contributed to the clinical manifestation of ITP, and antepartal bleeding took place in 18%, and preeclampsia emerged in 6%. The chronic ITP showed exacerbation during pregnancy in 27.3%, thus causing antepartal bleeding in 4.5% and postpartal bleeding in 15.9%. Postpartal bleeding presented in total 20%, not only in cases with severe ITP, but also in moderate ones. Postpartal blood transfusion was needed in 16%. The postpartal reduction of hemoglobin level determined 2-3 days following delivery was higher than in those ITP patients who had no postpartal haemorrhage than that in the general obstetrical population. This suggests an increased blood loss associated with delivery in patients with ITP. Maternal morbidity of patients with ITP in whom the disease first manifested during pregnancy was higher than that of those patients in whom pregnancy was associated with the remission of ITP. In order to decrease the maternal risks in ITP we advise that pregnancy should occur and be carried during remission.