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Am J Obstet Gynecol. 2010 Aug;203(2):135.e1-14. doi: 10.1016/j.ajog.2010.03.011. Epub 2010 May 21.

Intracranial hemorrhage in alloimmune thrombocytopenia: stratified management to prevent recurrence in the subsequent affected fetus.

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  • 1Department of Pediatrics and Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY 10065, USA. jbussel@med.cornell.edu

Abstract

OBJECTIVE:

We sought to prevent intracranial hemorrhage (ICH) through antenatal management of alloimmune thrombocytopenia.

STUDY DESIGN:

A total of 33 women (37 pregnancies) with alloimmune thrombocytopenia and ICH in a previous child were stratified according to the timing of the previous child's ICH: extremely high risk (HR) (n = 8) had ICH <28 weeks, very HR (n = 17) between 28-36 weeks, and HR (n = 12) in the perinatal period. Treatment was initiated at 12 weeks with intravenous immunoglobulin 1 or 2 g/kg/wk, and if the fetal platelet count by cordocentesis was <30,000/mL despite treatment, prednisone and/or more intravenous immunoglobulin were added.

RESULTS:

Five of 37 fetuses suffered ICHs. Two ICHs had platelet counts >100,000/mL, and 1 was grade I. The other 2 ICHs were unequivocal treatment failures; both were grade III-IV and resulted in fetal demise.

CONCLUSION:

These findings demonstrate the success of stratified treatment in these HR patients, which tailored interventions according to the timing of the sibling's ICH.

Copyright (c) 2010 Mosby, Inc. All rights reserved.

PMID:
20494333
[PubMed - indexed for MEDLINE]
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