Platelet and hemorrhagic disorders associated with pregnancy: a review. Part I

Disorders of coagulation remain an important potential cause of maternal morbidity and mortality. Bleeding disorders in pregnancy, unlike disorders of hypercoagulability, most often can have little impact on the mother but devastating consequences for the fetus. Further complicating the issue is that not all disorders of coagulation are inherited. Some are due to maternal illnesses unique to pregnancy, others are due to drug ingestion, and yet others remain idiopathic. In still other instances, thrombocytopenia is a minor consequence of a more severe disorder and will resolve when the inciting agent is removed or treated. A basic understanding of the pathophysiology of various conditions that lead to bleeding diathesis in pregnancy is necessary in order to effectively manage these varied clinical disorders. In addition, knowledge of whether the major morbidity is fetal or maternal or both can impact management. This review is concerned with the etiology, pathophysiology, diagnosis, and general management of commonly encountered disorders in pregnancy that place the mother and fetus at increased morbidity and mortality because of the potential for hemorrhage. Acutely acquired disorders and the resultant maternal manifestation versus a chronic disease process that is altered by the state of pregnancy are distinguished. Where possible, the incidence and prognosis of the disorder are provided. Actual cases are included to illustrate how similar presentations of distinctly different disorders can confuse and complicate an accurate diagnosis that is essential for appropriate management.