Document Detail


A less invasive treatment strategy to prevent intracranial hemorrhage in fetal and neonatal alloimmune thrombocytopenia.
MedLine Citation:
PMID:  11568798     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The purpose of this study was to evaluate whether a less invasive treatment strategy results in a higher platelet count of the neonate and prevents intracranial hemorrhage in pregnant women who are at risk for fetal or neonatal alloimmune thrombocytopenia. STUDY DESIGN: Between March 1989 and August 2000, 48 women with 56 pregnancies were treated. The population was divided into groups. A diagnostic fetal blood sample was taken in 7 cases that had a history of a sibling with an intracranial hemorrhage (group I; n = 8); treatment was provided, when necessary, with platelet transfusions and maternal administration of immunoglobulin. The other 48 cases, with a history of a sibling with severe thrombocytopenia but without intracranial hemorrhage, were retrospectively divided into group IIa (n = 16) and IIb (n = 32). In group IIa, at least 2 diagnostic fetal blood samples were taken, and when necessary, intrauterine platelet transfusion and immunoglobulin were administered (invasive treatment). In group IIb, no initial diagnostic fetal blood sampling was performed (noninvasive treatment). In 23 cases, immunoglobulin was administered, which was followed by predelivery fetal blood sampling in 8 cases. In 9 cases, only predelivery fetal blood sampling was performed, when necessary, followed by intrauterine platelet transfusion. RESULTS: Results of our noninvasive treatment strategy were comparable to results of the invasive method in the prevention of intracranial hemorrhage (intracranial hemorrhage was not observed). In addition, there was an increasing trend in median platelet count and a lower number of cases with severe thrombocytopenia (<50 x 10(9)/L) in the noninvasive compared with the invasive treatment group (median platelet count, 92 and 31 x 10(9)/L, respectively). CONCLUSION: Our results indicate that a less invasive treatment strategy in patients who are at risk for fetal or neonatal alloimmune thrombocytopenia and who have no history of a previous child who was affected with intracranial hemorrhage seems justified.
Authors:
C M Radder; A Brand; H H Kanhai
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  185     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2001 Sep 
Date Detail:
Created Date:  2001-09-24     Completed Date:  2001-10-11     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  683-8     Citation Subset:  AIM; IM    
Affiliation:
Leiden University Medical Center, Department of Obstetrics, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adult
Cerebral Hemorrhage / genetics,  prevention & control*
Female
Fetus
Humans
Immune System Diseases / blood,  physiopathology,  therapy*
Infant, Newborn
Platelet Count
Pregnancy
Severity of Illness Index
Thrombocytopenia / blood,  physiopathology,  therapy*

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