Associate Professor Foundation University Islamabad Pakistan islamabad, Islamabad, Pakistan
Background: Immune thrombocytopenic purpura (ITP) occurs in 1 to 2 of every 1,000 pregnancies. Management of ITP in pregnancy can be a complex and challenging task and requires multidisciplinary approach.
Aims: Systematic review of literature to evaluate the clinical characteristics and maternal/neonatal outcomes in pregnant women with ITP.
Methods: Literature search (1959- 2021) on ITP in pregnancy was performed using PubMed, Embase and Cochrane. Pooled estimates expressed as percentage (%) with 95% confidence interval (CI) were generated using inverse-variance weighted method in random-effect models.
Results: 81 articles met our inclusion criteria (35 case reports, 16 case series, 19 observational studies and 11 review articles). 1169 pregnant females aged 16-45 years had ITP. (44%, 95% CI = 33-64) had ITP diagnosed before pregnancy and (56%, 95% CI = 39-68) had ITP diagnosed during pregnancy. The commonest maternal complication was postpartum haemorrhage (PPH) (16%, 95% CI=11-23). Vaginal delivery was done in (60%, 95% CI= 39-70) while (40%, 95% CI= 27-61) had caesarean section. There was no maternal death. Management during pregnancy included glucocorticoids (GC) (46%, 95% CI =35-68), GC + Intravenous immunoglobulins (IVIg) (31%,95% CI=21-55), Eltrombopag (0.34%, 95% CI = 0.13-0.8), Rituximab (0.25%, 95% CI= 0.05-0.75), splenectomy (0.76%, 95% CI= 0.28-0.95) and anti-RhD Immunoglobulin (0.16% 95%CI= 0.01-0.4) Neonatal outcomes were: (09%, 95% CI=05-13) preterm births, (0.68%, 95% CI= 0.21-1.21) intracranial haemorrhage, (0.76%, 95% CI= 0.33-0.98) intrauterine fetal death, (0.25% 95% CI= 0.06-0.67) still births, (0.17% 95% CI= 0.02-0.35) infantile deaths, (2.5% 95% CI=1.8-3.7%) low birth weight babies and (0.8%, 95% CI= 0.3-1.0) fetal anomalies. (41%,95% CI=29-61) had neonatal thrombocytopenia out of which (21%,95% CI=17-30) neonates required treatment.
Conclusion(s): Pregnant patients with ITP usually have a good maternal/neonatal outcome. However, there is a higher risk of PPH which requires close monitoring. This systemic review constitutes an essential step to identify gaps in knowledge of ITP in pregnancy.