scholarly journals Modern approaches for perinatal management in thrombocytopenia during pregnancy

2021 ◽  
pp. 64-69
Author(s):  
О.М. Naumchik ◽  
◽  
Iu.V. Davydova ◽  
A.Yu. Limanska ◽  
◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Pregnant Women ◽  
Immune Thrombocytopenia ◽  
First Trimester ◽  
Care Plan ◽  
General Tendency ◽  
Gestational Thrombocytopenia ◽  
Target Values ◽  
Minimum Number ◽  
Perinatal Management

The most common diseases of the blood system in pregnant women are anemia and thrombocytopenia (TP). There is a general tendency to significantly reducing of the number of platelets during pregnancy, starting from the first trimester with a minimum number of them during childbirth. Purpose — to learn the features of motion of pregnancy, diagnostic and curative tactician at the thrombocytopenia during pregnancy. The causes of TP during pregnancy are three groups of conditions — conditions for which TP is characteristic outside of pregnancy and conditions associated with pregnancy: gestational thrombocytopenia (GTP), pregnancy-specific complications, manifestations of diseases characterized by TP, with the chief reason among them — immune thrombocytopenia (ITP). The most common cause of TP during pregnancy is GTP, which, like ITP, is diagnose of exclusion that require differential diagnosis. The goal of treating TP during pregnancy is to achieve a safe platelet count that is different for each trimester, not target values. If the treatment of ITP is need lines of therapy with control of efficiency are consistently applied. Pregnant women with moderate and severe TP are a group of high perinatal risk, requiring careful differential diagnosis of the causes of TP, calculation of maternal and fetal risks, choice of tactics of such pregnancy, method and time of delivery, formation of postnatal care plan. No conflict of interest was declared by the authors. Key words: pregnancy, thrombocytopenia, immune thrombocytopenia, gestational thromocytopenia.

Thrombocytopenia during pregnancy

2006 ◽  
Vol 26 (01) ◽  
pp. 72-74 ◽  
Author(s):  
F. Boehlen
Keyword(s):  
Differential Diagnosis ◽  
Platelet Count ◽  
Adverse Effects ◽  
Pregnant Women ◽  
Spontaneous Resolution ◽  
Thrombocytopenic Purpura ◽  
Common Cause ◽  
Gestational Thrombocytopenia ◽  
Neonatal Thrombocytopenia ◽  
Few Data

SummaryThrombocytopenia is observed in 6 to 15% of pregnant women at the end of pregnancy, and is usually moderate. Gestational thrombocytopenia (defined as a mild thrombocytopenia, occurring during the 3rd trimester with spontaneous resolution postpartum and no neonatal thrombocytopenia) is the most common cause of thrombocytopenia during pregnancy but a low platelet can also be associated with several diseases, either pregnancy specific or not, such as preeclampsia, HELLP syndrome, or idiopathic thrombocytopenic purpura (ITP). The differential diagnosis between ITP and gestational thrombocytopenia is clinically important with regard to the fetus, due to the risk of neonatal thrombocytopenia. However, this differential diagnosis is very difficult during pregnancy.Thrombocytopenia which need to be investigated are the following: thrombocytopenia known before pregnancy, thrombocytopenia occurring during the 1st and 2nd trimester, platelet count < 75 G/l in the 3rd trimester or thrombocytopenia in case of pregnancy with complications. Investigations have to be discussed in function of history and clinical examination, gestational age and severity of thrombocytopenia.No treatment is required in case of gestational thrombocytopenia. There are few data to distinguish management of ITP between pregnant and non-pregnant women but management is different because of the potential adverse effects of the treatment for the woman and/or the fetus, the requirement for a good hemostasis at delivery and the risk of neonatal hemorrhage. One important problem is that it is not possible to predict the risk of neonatal thrombocytopenia in babies born from women with ITP.

scholarly journals ANALYSIS OF THE PLATELET HEMOSTASIS AMONG PREGNANT WOMEN WITH IMMUNE THROMBOCYTOPENIA

2021 ◽  
pp. 61-75
Author(s):  
Yu.V. Davidova ◽  
V.Z. Netyazhenko ◽  
A.N. Naumchik ◽  
N.I. Kozachishin ◽  
A. Yu. Limanskaya
Keyword(s):  
Platelet Aggregation ◽  
Pregnant Women ◽  
Immune Thrombocytopenia ◽  
Obstetric Care ◽  
Severe Thrombocytopenia ◽  
Direct Function ◽  
Functional Potential ◽  
Gestational Thrombocytopenia ◽  
Gynecological Care ◽  
Frequent Reason

Relevance: Thrombocytopenia is a common hematological problem that accompanies pregnancy. From 5% to 12% of pregnancies are complicated by thrombocytopenia. Gestational thrombocytopenia is the leading cause of complications (70-85%). Immune thrombocytopenia (ITP) is the most frequent reason among pre-pregnancy causes of thrombocytopenia and is responsible for 1-4% of all thrombocytopenia cases during pregnancy. Investigation of the functional potential of the thrombocyte link of hemostasis in conditions of a reduced number of thrombocytes is relevant. The purpose of the study was to analyze the platelet link of hemostasis in pregnant women with ITP of varying severity by the method of light aggregometry. Materials and Methods: Eighty-eight women with gestational and 28 with immune thrombocytopenia were undergoing treatment and delivery at the Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine (Kyiv, Ukraine) from September 2018 to February 2021. The platelet link of hemostasis was studied in a group of women with immune thrombocytopenia; six (21.4%) of them had severe thrombocytopenia. Results: In mild and moderate immune thrombocytopenia, we noted a decrease in spontaneous and induced platelet aggregation; in severe immune thrombocytopenia, there was no spontaneous and a decreased induced platelet aggregation. This indicated a reduced potential of platelets to perform their direct function – the formation of a thrombus. Conclusion: Immune thrombocytopenia accounts for most pre-pregnancy conditions causing thrombocytopenia in pregnant women. Light aggregometry is a relevant and indicative way to analyze the aggregative ability of platelets. A multidisciplinary team consisting of an obstetrician-gynecologist, hematologist, anesthesiologist, and neonatologist should be involved in the management of such cases to provide effective obstetric care for this category of pregnant women. Risks for the mother and the fetus/newborn should be assessed throughout the pregnancy, considering clinical and laboratory aspects. Delivery of pregnant women with severe thrombocytopenia should be managed at institutions providing the highest level of obstetric and gynecological care.

How I treat thrombocytopenia in pregnancy

Blood ◽  
2013 ◽  
Vol 121 (1) ◽  
pp. 38-47 ◽  
Author(s):  
Terry Gernsheimer ◽  
Andra H. James ◽  
Roberto Stasi
Keyword(s):  
Immune Thrombocytopenia ◽  
Systematic Approach ◽  
Thrombocytopenic Purpura ◽  
Case Presentation ◽  
Gestational Thrombocytopenia ◽  
Clinical Scenarios ◽  
Primary Immune Thrombocytopenia ◽  
Uremic Syndrome ◽  
Perinatal Management ◽  
Disease Entities

Abstract A mild thrombocytopenia is relatively frequent during pregnancy and has generally no consequences for either the mother or the fetus. Although representing no threat in the majority of patients, thrombocytopenia may result from a range of pathologic conditions requiring closer monitoring and possible therapy. Two clinical scenarios are particularly relevant for their prevalence and the issues relating to their management. The first is the presence of isolated thrombocytopenia and the differential diagnosis between primary immune thrombocytopenia and gestational thrombocytopenia. The second is thrombocytopenia associated with preeclampsia and its look-alikes and their distinction from thrombotic thrombocytopenic purpura and the hemolytic uremic syndrome. In this review, we describe a systematic approach to the diagnosis and treatment of these disease entities using a case presentation format. Our discussion includes the antenatal and perinatal management of both the mother and fetus.

scholarly journals Differential diagnosis of thrombocytopenia during pregnancy: clinical and diagnostic algorithms

2021 ◽  
pp. 28-40
Author(s):  
O.M. Naumchik ◽  
◽  
Iu.V. Davydova ◽  
A.Yu. Limanska ◽  
◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Pregnant Women ◽  
Immune Thrombocytopenia ◽  
Clinical Laboratory ◽  
Treatment Algorithm ◽  
Laboratory Data ◽  
Diagnostic Algorithm ◽  
State Institution ◽  
Perinatal Complications ◽  
Pregnancy And Childbirth

Purpose — to create an algorithm for early diagnosis and differential diagnosis of conditions accompanied by thrombocytopenia (TP) during pregnancy, as well as an algorithm for the treatment of immune thrombocytopenia during pregnancy based on analysis of clinical, laboratory data and obstetric and perinatal results of such pregnant women. Materials and methods. We analyzed 155 histories of pregnancy and childbirth of women with TP, who underwent inpatient treatment and/or gave childbirth in the obstetric clinic of the State Institution «Institute of Pediatrics, Obstetrics and Gynecology named after Academician O.M. Lukyanova NAMS of Ukraine» from January 2008 to August 2018. According to the inclusion criteria, 111 histories were selected for further analysis. Pregnant women are divided according to the etiological principle of TP into three groups: with gestational thrombocytopenia, immune thrombocytopenia, secondary thrombocytopenia. The first group included 32 women (28.8%), the second — 65 (55.6%), the third — 14 (12.6%). During the selected period of time there were 99 births, 100 babies were born, 1 twin birth. Results and conclusions. The number of platelets progressively decreases during pregnancy with a minimum in childbirth. The algorithm of examination, the decision on the initiation or intensification of treatment, the choice of monitoring tactics for TP during pregnancy, the calculation of obstetric and perinatal risks, preparation for childbirth and the choice of method depend on the cause of TP and differ significantly. Developed «Algorithm for diagnosis and differential diagnosis in the detection of thrombocytopenia during pregnancy» and «Algorithm for the treatment of immune thrombocytopenia during pregnancy» are aimed at the prevention of obstetric and perinatal complications in pregnant women with thrombocytopenia. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of an participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: thrombocytopenia, pregnancy, diagnostic algorithm, treatment algorithm.

Optimisation of tactics of conducting pregnancy and labours at women after auxiliary reproductive technologies

2016 ◽  
pp. 160-164
Author(s):  
D.N. Maslo ◽  
Keyword(s):  
Pregnant Women ◽  
Resistance Index ◽  
First Trimester ◽  
Reproductive Technologies ◽  
Premature Delivery ◽  
Control Group ◽  
Uterine Arteries ◽  
Placental Dysfunction ◽  
Placental Blood ◽  
Two Stages

The objective: frequency decrease perinatal pathologies at women after ART on the basis of studying clinical-ehografical, endocrinological, biochemical, dopplerometrical, cardiotokografical and morphological researches, and also improvement of algorithm of diagnostic and treatment-and-prophylactic actions. Patients and methods. The work basis is made spent by us from 2012 on 2015 by complex inspection of 300 pregnant women from which 250 were after ART and 50 – firstlabours which pragnency without ART, and also their newborns. For the decision of an object in view of research spent to two stages. At 1 stage spent prosperctive research which included 150 pregnant women: з them 100 women pregnancy at which has come out ART (1 group) and 50 healthy women (control group). At 2 stage spent prospective randomization in which result of patients after ART have divided on two equal groups by therapy principle: 2 basic group - 75 pregnant women after ART at which used the algorithm improved by us; 3 group of comparison - 75 pregnant women after ART which have been spent on the standard treatment-and-prophylactic actions. Results. The results suggest that women after using ART is a high frequency of reproductive losses in the first trimester (10.0%), 3.0% of spontaneous abortion from 16 to 22 weeks, and 3.0% "early" premature delivery (22 to 28 weeks of pregnancy). The frequency of violations of the functional state of placenta in women after using IVF is 63.0%, which is the main cause of high levels of perinatal losses (40.0 ‰), and delivery by cesarean section (96.0%). Placental dysfunction in women after using ART characterized by retrohorialnyh hematoma (21.0%); size mismatch fruit (30.0%) and hypertonicity of the uterus (73.0%) against changes in fruit-placental blood flow - increased resistance index in umbilical artery and increased vascular resistance in the uterine arteries. Endocrinological and biochemical changes in placental dysfunction in women after using IVF starting from 28 weeks of pregnancy and are in significant reduction in progesterone, placental b1-microglobulin, B2-microglobulin of fertility and trophic в-glycoprotein. Conclusion. The received results: use of the algorithm of diagnostic and treatment-and-prophylactic actions improved by us allows to lower frequency of spontaneous interruption of pregnancy till 22 weeks – from 13.0% to 5.7%; «early» premature birth – from 3.0% to 1.0%; placentary dysfunction from 63.0% to 40.6%; cesarean sections – from 96.0% to 56.5%, and also perinatal losses – from 40.0‰ to 16.2‰. Key words: pregnancy, childbirth, auxiliary reproductive technologies.

86-LB: Elevated First-Trimester Neutrophil Count Is Associated with the Development of Gestational Diabetes Mellitus in Pregnant Women

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 86-LB
Author(s):  
TIANGE SUN ◽  
FANHUA MENG ◽  
RUI ZHANG ◽  
ZHIYAN YU ◽  
SHUFEI ZANG ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Neutrophil Count ◽  
First Trimester

Inadequate Dietary Intakes: Among Pregnant Women

2012 ◽  
Vol 73 (2) ◽  
pp. 72-77 ◽  
Author(s):  
Jennifer K. Fowler ◽  
Susan E. Evers ◽  
M. Karen Campbell
Keyword(s):  
Pregnant Women ◽  
Food Group ◽  
Reproductive Age ◽  
Dietary Intakes ◽  
Food Groups ◽  
Eating Behaviours ◽  
Prenatal Health ◽  
Canadian City ◽  
Minimum Number ◽  
Health Project

Purpose: Eating behaviours were assessed among pregnant women in a mid-sized Canadian city. Methods: As part of the Prenatal Health Project, we interviewed 2313 pregnant women in London, Ontario. Subjects also completed a food frequency questionnaire. Recruitment took place in ultrasound clinics at 10 to 22 weeks of gestation. The main outcome measures were number of daily servings for each food group, measured against the minimum number recommended by the 2007 Eating Well with Canada’s Food Guide (CFG), the proportion of women consuming the recommended number of servings for each and all of the four food groups, and factors associated with adequate consumption. We also determined the number of servings of “other foods.” Analysis included descriptive statistics and logistic regression, all at p<0.05. Results: A total of 3.5% of women consumed the recommended number of servings for all four food groups; 15.3% did not consume the minimum number of servings of foods for any of the four food groups. Women for whom this was their first pregnancy were less likely to consume the recommended number of servings from all four food groups (odds ratio=0.41; confidence interval=0.23, 0.74). Conclusions: Very few pregnant women consumed food group servings consistent with the 2007 recommendations. Strategies to improve dietary behaviours must focus on the establishment of healthy eating behaviours among women of reproductive age.

scholarly journals Identifying Patterns of Symptom Distress in Pregnant Women: A Pilot Study

2021 ◽  
Vol 18 (12) ◽  
pp. 6333
Author(s):  
Ching-Fang Lee ◽  
Fur-Hsing Wen ◽  
Yvonne Hsiung ◽  
Jian-Pei Huang ◽  
Chun-Wei Chang ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Healthcare Providers ◽  
First Trimester ◽  
Symptom Distress ◽  
Teaching Hospitals ◽  
Lower Back ◽  
Distress Symptoms ◽  
Related Symptom ◽  
Experienced Symptom

During pregnancy, a woman’s enlarged uterus and the developing fetus lead to symptom distress; in turn, physical and psychological aspects of symptom distress are often associated with adverse prenatal and birth outcomes. This study aimed to identify the trends in the trajectory of these symptoms. This longitudinal study recruited 95 pregnant women, with a mean age of 32 years, from the prenatal wards of two teaching hospitals in northern Taiwan. Symptom distress was measured by a 22-item scale related to pregnancy-induced symptoms. The follow-up measurements began during the first trimester and were taken every two to four weeks until childbirth. More than half of the pregnant women experienced symptom distress manifested in a pattern depicted to be “Decreased then Increased” (56.8%). Other noticeable patterns were “Continuously Increased” (28.4%), “Increased then Decreased” (10.5%) and “Continuously Decreased” (4.2%), respectively. It is worth noting that most pregnant women recorded a transit and increase in their symptom distress, revealed by their total scores, at the second trimester (mean 22.02 weeks) of pregnancy. The participants’ major pregnancy-related distress symptoms were physical and included fatigue, frequent urination, lower back pain, and difficulty sleeping. The mean scores for individual symptoms ranged from 2.32 to 3.61 and were below the “moderately distressful” level. This study provides evidence that could be used to predict women’s pregnancy-related symptom distress and help healthcare providers implement timely interventions to improve prenatal care.

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