Chronic villitis in untreated neonatal alloimmune thrombocytopenia: an etiology for severe early intrauterine growth restriction and the effect of intravenous immunoglobulin therapy.

Abstract

OBJECTIVE:

The objective of the study was to examine placental histopathology in intravenous immunoglobulin-treated and untreated neonatal alloimmune thrombocytopenia and correlate pathological findings with clinical outcomes.

STUDY DESIGN:

Placentas from 14 neonatal alloimmune thrombocytopenia-affected pregnancies were identified. Maternal antepartum treatment with intravenous immunoglobulin and pregnancy outcomes were abstracted from medical records. Placental histopathology and clinical outcomes were compared between intravenous immunoglobulin and no intravenous immunoglobulin treatment groups using Fisher's exact test. One subject, treated only after an intracranial hemorrhage (ICH) was diagnosed, was excluded from the analysis. P < .05 was considered significant.

RESULTS:

Untreated pregnancies demonstrated a lymphoplasmacytic chronic villitis not seen in the intravenous immunoglobulin-treated pregnancies (P = .005). Intrauterine growth restriction and intrauterine fetal demise occurred as frequently as ICH in the untreated group. No ICH, intrauterine growth restriction, or intrauterine fetal demises occurred in the treated group, although the P value was not significant.

CONCLUSION:

Chronic villitis is frequently manifest in neonatal alloimmune thrombocytopenia, with intravenous immunoglobulin alleviating this inflammatory immunologic response. We suspect a more universal role for the maternal antibody, such as fetal endothelial cell damage, in the sequelae of neonatal alloimmune thrombocytopenia.

• Authors: Janyne Althaus, Edward G Weir, Fred Askin, Thomas S Kickler, Karin Blakemore
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 193 Issue 3 Pt 2 Pg. 1100-4 (Sep 2005) ISSN: 0002-9378 [Print] United States
• PMID: 16157119 (Publication Type: Journal Article)

Chemical References

• Immunoglobulins, Intravenous

Topics

• Chorionic Villi (pathology)
• Female
• Fetal Growth Retardation (etiology, immunology)
• Humans
• Immunoglobulins, Intravenous (therapeutic use)
• Inflammation (drug therapy, epidemiology, immunology)
• Placenta Diseases (complications, epidemiology)
• Pregnancy
• Retrospective Studies
• Thrombocytopenia (drug therapy, epidemiology, immunology)