Severe immune thrombocytopenia in pregnancy: a case report

Authors

  • Shamrao Ramji Wakode Department of Obstetrics and Gynecology, S. C. G. M. C., Nanded, Maharashtra, India
  • Sakshi Pramod Sharma Department of Obstetrics and Gynecology, S. C. G. M. C., Nanded, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20240493

Keywords:

Immune thrombocytopenia, ITP, Platelet, Pregnancy management

Abstract

Pregnancy when complicated with severe immune thrombocytopenia is a challenge both during labour and peripartum period. It’s management requires a multidisciplinary care approach. Severity of ITP may have adverse consequences on both maternal and fetal outcome. Present case report is of a patient with findings of chronic thrombocytopenia who came to antenatal outpatient department at 28 years of age with 7 months of amenorrhea with history of bleeding gums and purpura. She was monitored throughout third trimester of pregnancy. Ultrasonography findings showed severe oligohydramnios at 38 weeks and based on obstetric indications, elective cesarean section was planned after consultation with anesthetist and hematologist. Patient landed in intraoperative postpartum hemorrhage and was managed with medical management along with glove balloon tamponade. Patient was discharged on day 10 day along with her newborn. It shows that close monitoring of the clinical course and multidisciplinary care is critical to reach the correct treatment implication as well as potential management of such cases.

 

References

Singh J, Kumari K, Verma V. Study of thrombocytopenia in pregnancy: clinical presentation and outcome at tertiary care rural institute. Int J Reprod Contracept Obstet Gynecol. 2020;9:1622-6.

Provan D, Arnold DM, Bussel JB, Chong BH, Cooper N, Gernsheimer T, et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv. 2019;3(22):3780-817.

Eltrombopag TA, Olan Gebede C, Immun T, Bir VR. Severe Immune Thrombocytopenia in Pregnancy Treated with Eltrombopag. A Case Report. J DEU Med. 2022;36(1):73-6.

Cines DB, Levine LD. Thrombocytopenia in pregnancy. Blood. 2017;130(21):2271-7.

Wang X, Xu Y, Luo W, Feng H, Luo Y, Wang Y, et al. Thrombocytopenia in pregnancy with different diagnoses: Differential clinical features, treatments, and outcomes. Medicine (Baltimore). 2017;96(29):e7561.

Wang X, Xu Y, Luo W, Feng H, Luo Y, Wang Y, et al. Thrombocytopenia in pregnancy with different diagnoses: Differential clinical features, treatments, and outcomes. Medicine (Baltimore). 2017;96(29):e7561.

Kashyap R, Garg A, Pradhan M. Maternal and Fetal Outcomes of Pregnancy in Patients with Immune Thrombocytopenia. J Obstet Gynaecol India. 2021;71(2):124-30.

Jacqueline NP, Terry B. Gernsheimer. Management of immune thrombocytopenia in pregnancy. Ann Blood. 2021;6:5.

Liu J, Zhang L. Primary Immune Thrombocytopenia in Pregnancy: Pathology, Diagnosis, and Management. Glob Med Genet. 2023;10(4):282-4.

Sayed G, ElKourashy SA, Alnajjar M, Mallahi NA, Fareed S. Case Report: Thrombopoietin receptor agonists in resistant thrombocytopenia in pregnancy: a case series and review of literature. Front. Hematol. 2023;2:1180156.

Wyszynski DF, Carman WJ, Cantor AB, Graham JM Jr, Kunz LH, Slavotinek AM, et al. Pregnancy and Birth Outcomes among Women with Idiopathic Thrombocytopenic Purpura. J Pregnancy. 2016;2016:8297407.

Yassaee F, Eskandari R, Amiri Z. Pregnancy outcomes in women with idiopathic thrombocytopenic purpura. Iran J Reprod Med. 2012;10(5):489-92.

Tasneem F, Sharma VM. Glove balloon uterine tamponade for post-partum haemorrhage: indigenous, readily available, cheap, easy to learn and practice, yet effective. Int J Res Med Sci. 2021;9:538-41.

Gilmore KS, McLintock C. Maternal and fetal outcomes of primary immune thrombocytopenia during pregnancy: A retrospective study. Obstet Med. 2018;11(1):12-6.

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Published

2024-02-27

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Section

Case Reports