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Alloimmune thrombocytopenia: fetal and neonatal losses related to cordocentesis
M J Paidas1, R L Berkowitz, L Lynch
1Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai Medical Center, New York, New York.
Objective:
This report describes the increased risks of cordocentesis in fetuses affected with alloimmune thrombocytopenia.
Study Design:
As part of a multicenter treatment study clinical and laboratory data from five pregnancies with alloimmune thrombocytopenia in which there was a fetal or neonatal loss associated with cordocentesis were reviewed. The fetal or neonatal deaths were all thought to be a result of exsanguination. These fetuses were compared with a group of 44 affected fetuses who underwent the same procedure but who survived. The data were analyzed by the Wilcoxon rank-sum test and the two-tailed Fisher's exact test. A p value < 0.05 was considered significant.
Results:
The mean platelet count at cordocentesis was significantly lower in the cases than in the controls (5.8 vs 32.8 x 10(9)/L, p = 0.005). The incidence of antenatal intracranial hemorrhage in the untreated sibling of the prior affected pregnancy was significantly greater in the cases than in the controls (two of five vs one of 42, p = 0.02).
Conclusion:
Fetuses affected with alloimmune thrombocytopenia are at increased risk for fatal exsanguination associated with cordocentesis.