Abstract | OBJECTIVE: METHODS: In these parallel, randomized, multicenter studies, 78 patients in 79 pregnancies were stratified to 2 different treatment arms based on the presence of a peripartum intracranial hemorrhage in a previously affected sibling and/or the initial fetal platelet count. Patients with a history of an antenatal intracranial hemorrhage in a prior pregnancy were excluded. RESULTS: Forty women whose children from a previous birth had a peripartum intracranial hemorrhage or whose current fetus had an initial platelet count less than 20,000/mL3 were randomly assigned to receive IVIG plus prednisone or IVIG alone. The mean increase in fetal platelet counts in the following 3 to 8 weeks was 67,100/mL3 and 17,300/mL3, respectively (P < .001). Thirty-nine patients whose prior affected child did not have an intracranial hemorrhage and whose initial platelet count was more than 20,000/mL3 were randomly assigned to receive IVIG alone or prednisone alone. There were no significant differences, and 33 (85%) had birth platelet counts more than 50,000/mL3. There were 11 (6%) significant complications after a total of 175 fetal blood sampling procedures, 2 of which led to fetal or neonatal deaths. CONCLUSION: The spectrum of disease severity of alloimmune thrombocytopenia is reflected in the initial fetal platelet count and response to therapy. Fetal blood sampling may be associated with significant fetal/neonatal morbidity and mortality. Empiric therapy sufficient to treat the most severely affected fetuses will overtreat others and is likely to be associated with additional maternal morbidity.
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Authors | Richard L Berkowitz, E Anders Kolb, Janice G McFarland, Megan Wissert, Andrea Primani, Martin Lesser, James B Bussel |
Journal | Obstetrics and gynecology
(Obstet Gynecol)
Vol. 107
Issue 1
Pg. 91-6
(Jan 2006)
ISSN: 0029-7844 [Print] United States |
PMID | 16394045
(Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Immunoglobulins, Intravenous
- Prednisone
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Topics |
- Adult
- Autoimmune Diseases
(diagnosis, drug therapy, immunology)
- Cross-Over Studies
- Dose-Response Relationship, Drug
- Drug Administration Schedule
- Drug Therapy, Combination
- Female
- Fetal Death
- Fetal Diseases
(diagnosis, drug therapy)
- Follow-Up Studies
- Gestational Age
- Humans
- Immunoglobulins, Intravenous
(administration & dosage)
- Maternal Age
- Prednisone
(administration & dosage)
- Pregnancy
- Pregnancy Outcome
- Reference Values
- Risk Assessment
- Thrombocytopenia
(diagnosis, drug therapy, immunology)
- Treatment Outcome
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