Immune thrombocytopenic purpura in pregnancy: the ongoing debate surrounding obstetric management

Thrombocytopenia is a common hematologic complication of pregnancy. Most cases are the result of gestational thrombocytopenia, which poses no threat to mother or fetus. In contrast, other cases may be secondary to immune thrombocytopenic purpura (ITP), which may cause significant hemorrhagic morbidity in both. For this reason, diagnosing and treating ITP in pregnancy is important. The medical management of the disease is well established and has changed little. Conversely, obstetric management protocols have changed a great deal as our perception of fetal risk has been altered. Throughout the 1990s, many authors have reviewed the literature and challenged the existing belief that ITP is frequently associated with significant fetal morbidity. This has forced a revision of previous obstetric management recommendations. Despite evidence provided by these recent reviews, obstetric management of ITP in pregnancy remains an area of considerable controversy.