Gestational thrombocytopenia: a prospective study

Department of Hematology, San Bortolo Hospital, Vicenza, Italy.

Gestational thrombocytopenia (GT) is commonly observed in pregnancies with otherwise limited obstetric and hematologic complications. However, few data are available on the natural history of the disease, and on the recurrence of thrombocytopenia in subsequent pregnancies. From June 1987 to December 1993, 37 consecutive patients with GT were enrolled in a prospective study, with a total of 41 pregnancies observed. Vaginal delivery was carried out in 33/41 (80%); two patients were transfused fused with packed red cells for obstetric hemorrhage (post-partum uterine atony). Neonatal bleeding did not occur. In all newborns platelet count was performed within 24 hours after delivery: 2 newborns had mild (80 and 75 x 10(9)/L) and 1 severe thrombocytopenia (12 x 10(9)/L) at birth; all of them recovered to a normal platelet count within 10 days without treatment. Twenty-eight out of 3% patients were followed for 12 months after delivery; in 23 a normalization of platelet count occurred within 1-5 months from delivery; in 5 mild thrombocytopenia (100-120 x 10(9)/L) persisted during follow-up. Four patients had a second pregnancy and recurrence of thrombocytopenia was observed in all of them. GT is rarely associated with bleeding episodes during pregnancy and partum, and recovers spontaneously within few months after delivery but thrombocytopenia can recur in subsequent pregnancies. Severe thrombocytopenia is not observed in newborns so that a conservative management is warranted.