Abstract:
Background: Immune thrombocytopenic
purpura (ITP) can complicate pregnancy, which
requires optimal mtr-r-fTtsu- iplii ta-ry management
to prevent maternal and perinatal complications.
Current recommendations are for vaginal delivery
unless obstetrically indicated.
We report a case series of medically and obstetrically complicated ITP referrals from
multiple geographic locations in Sri Lanka, where
the best option was a combined splenectomy and
operative delivery.
Results: Between January 2003 to June 2005, 5
pregnant women with thrombocytopaenia were
referred to a single tertiary care unit. Age range:
28 - 35 years; POA ranging from 29 40 -weeks.
Three were primigravidae. One was in her 5 '
pregnancy with no living children and another in
her 8* pregnancy with 2 living children. The latter
two had severe PIH previously with fetal loss; the
P5 complicated by ileofemoral DVT and the P8
diagnosed to have antiphospholipid syndrome
and SLE.
Platelet counts ranged from 2,000 40,000/jul
despite all receiving steroid pulses and
immunosuppression and 3 also receiving
additional intravenous immunoglobulin. The
P8C2 had an intrauterine death at 29 weeks,
whilst the others had a viable fetus.
All were managed by a team of obstetric and
medical specialists, who reached a consensus
decision to deliver four by Caesarean, combined
with splenectomy; and the IUD by abdominal
hysterectomy combined with splenectomy under
general anaesthesia.
Surgery was tolerated well with no excessive
haemorrhage and maternal platelet counts
recovered within 12 hours of splenectomy.
Neonatal outcome was good in 4/4 with one
developing transient thrombocytopaenia.
Discussion and Conclusion: Optimum
individualized medical and surgical management
of severe maternal immune thrombocytopaenia in
pregnancy with a multidisciplinary approach in a
tertiary centre is recommended in the Sri Lankan
setting.
