[Autoimmune thrombocytopenia during pregnancy (case report and review of literature)].

A case of autoimmune thrombocytopenia [AIT], diagnosed in the first trimester of pregnancy is described. Despite the active treatment with steroids and IVIG the platelet count dropped to extremely low levels in the third trimester--8 x 10(9)/l. Labor was induced in 34 w.g. because of the ineffective treatment of AIT, clinical and sonographic evidence of IUGR and favorable pelvic score. Before and during labor induction platelets were transfused and recombinant factor VIIa (rFVIIa) was applied. After delivery antifibrinolytics as well as low molecular weight heparin [LMWH] were applied also. Laboratory tests demonstrated transient fibrinolysis activation after delivery. Mild transient thrombocytopenia of the newborn was found that was successfully treated with steroids. Review of contemporary literature is made with analysis of the therapeutic approaches in cases of AIT during pregnancy. The impact of thrombocytopenia on pregnancy, labor and delivery, the fetus and the newborn and the route of delivery are discussed. The clinical course and the therapeutic strategies in the particular case are analyzed. A nouvelle approach during labor and after delivery was the application of rFVIIa (because of the tendency for elevation of the titers of allogenic antibodies due to platelet transfusions) and of antifibrinolytics (preserving platelet functions).