Pregnancy complicated by refractory idiopathic thrombocytopenic purpura and diabetes mellitus

Idiopathic thrombocytopenic purpura (ITP) is an infrequent complication of pregnancy and can present significant maternal and fetal hazards when it occurs. The potential for serious maternal hemorrhage and the transplacental passage of antiplatelet antibodies, which may cause a similar fetal hemorrhage from thrombocytopenia, are factors that must be considered in the obstetric management of every gravida so affected. Because of the disease, both mother and fetus are often treated with potentially dangerous medications, and the mother may have intraabdominal surgery during pregnancy to remove a potentially diseased spleen. This paper reports on a gravida who responded poorly to both corticosteroids and splenectomy and who also had other obstetric complications. She gave birth to a fetus who initially showed evidence of thrombocytopenia but responded well to supportive treatment. Important obstetric aspects of ITP in pregnancy are reviewed.