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Route of delivery for patients with immune thrombocytopenic purpura

  • Russell K. Laros Jr.
    Correspondence
    Reprint requests: Dr. Russell K. Laros, Jr., M 1480, University of California (San Francisco), San Francisco, California 94143.
    Affiliations
    Department of Obstetrics, Gynecology and Reproductive Sciences, University of California (San Francisco) San Francisco, California USA.
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  • Risa Kagan
    Affiliations
    Department of Obstetrics, Gynecology and Reproductive Sciences, University of California (San Francisco) San Francisco, California USA.
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      Abstract

      Over the past 15 years, we managed 19 pregnancies in 18 women afflicted with immune thrombocytopenic purpura. Our policy has been to treat the mother with corticosteroids if her platelet count was below 100 × 109/L and to use cesarean section only for obstetric indications; 14 patients received corticosteroids. The perinatal outcomes were intrauterine fetal death (two), neonatal death (0), and live birth (17). The methods of delivery for the 17 live-born infants were spontaneous vaginal (seven), low forceps or midforceps (five), cesarean section (five). Although seven of the live-born infants (41%) were thrombocytopenic (<100 × 109/L), only two received therapy, and none suffered significant hemorrhagic morbidity. Maternal treatment with corticosteroids did not affect the neonatal platelet count, nor was there a correlation between maternal and neonatal platelet counts. On the basis of our experience, we think that cesarean section is not routinely indicated as the method of delivery for parturient patients with immune thrombocytopenic purpura.
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