In one large series of pregnant women with ITP, only approximately 30% required therapy.
However, patients who wish to receive epidural anesthesia, which may increase the risk of epidural hematoma formation, require higher platelet counts and a more aggressive approach.
Intravenous anti-D has also been used effectively for therapy of ITP in pregnancy, although in only a small number of reported cases.
For patients who do not respond to corticosteroids or IVIg as single agents, combinations of these therapies may sometimes be more effective, particularly when corticosteroids are delivered as high-dose “pulse” therapy (eg, methylprednisolone, 1 g/day for two consecutive days).
Patients with a history of primary or secondary immune thrombocytopenia (ITP), thrombocytopenia of any etiology preceding pregnancy, or any reason for thrombocytopenia other than uncomplicated pregnancy itself are generally not considered to have gestational thrombocytopenia.
However, in many cases, it may not be possible to distinguish gestational thrombocytopenia, particularly a more severe case, from ITP.
The goal of therapy for ITP in pregnant women is to prevent bleeding.
Generally, these individuals have mild thrombocytopenia that first becomes apparent in the mid-second to third trimester of pregnancy.
In the absence of a platelet increment, platelet transfusion may be used to raise the platelet count to a level deemed safe for epidural catheter placement if desired.), autoimmune disease, and other challenges, factors that induce primary ITP and why its course worsens in some pregnant patients are not well understood.
Of all cases of pregnancy-associated ITP, approximately one-third is first diagnosed during pregnancy, whereas two-thirds are in patients with preexisting disease.
Moreover, because therapeutic interventions used to treat thrombocytopenic disorders in pregnant women may have toxicities unique to pregnancy, management approaches must be carefully considered.
We will review the differential diagnosis of thrombocytopenia in pregnancy, discuss the relevant pathophysiologic mechanisms, and suggest strategies for optimal management.
The degree of maternal thrombocytopenia is generally not severe enough to increase the risk of bleeding with delivery, although some cases may compromise the ability to deliver epidural anesthesia.