Improved pregnancy outcome following earlier splenectomy in women with immune thrombocytopenia: a 5-year observational study.

OBJECTIVE: To assess prospectively the maternal and fetal outcome in women with immune thrombocytopenic purpura (ITP) who undergone earlier splenectomy compared to women on medical therapy.

METHODS: A 5-year observational study included pregnant women in the first trimester previously diagnosed with primary ITP with 74 patients underwent splenectomy before pregnancy and 86 patients on medical therapy. Patients were followed throughout pregnancy and labour to record their obstetric outcome. Data were collected and tabulated.

RESULTS: There was a higher platelet count in the splenectomy group at enrollment (p < .05) and at delivery (p < .001). Higher number of patients in the medical group experienced bleeding episodes (p < .001), severe thrombocytopenia (p < .001), need for therapy (p < .001), complications of steroid therapy (p < .05), postpartum hemorrhage (p < .05), and defective lactation (p < .001) compared to patients in the splenectomy group. Higher rates of small for gestational age, preterm labour, and admission to neonatal intensive care unit (NICU) were observed in patients in the medical group (p < .05) compared to patients in the splenectomy group.

CONCLUSION: Earlier splenectomy in patients with ITP may have a beneficial impact on obstetric outcome and should be explained to patients wishing to get pregnant. Further larger multicenter studies are warranted to confirm or refute our findings.