[Management of refractory autoimmune thrombocytopenic purpura during pregnancy, Review of the literature and report of three cases].

The immune thrombocytopenic purpura (ITP) is an immunological disease associated with pregnancy; it is difficult to control when there is not an adequate response to the treatment mainly with prednisone (refractory). When this problem occurs there are other ways to treat it: monthly pulses of dexamethasone (oral or intravenously), administration of gamma globulin or anti D and occasionally to perform a splenectomy. Three cases of refractory ITP and pregnancy are presented using different treatment in each case: Case 1 hyperimmune gammaglobulin; case 2 platelets by transfusion and in case number 3 monthly dexamethasone oral pulses. In the case treated with hyperimmune gammaglobulin the maternal response was acceptable but neonatal demise occurred due to hemorrhage; in the treated with platelets transfusion, there were maternal and fetal deaths; the best results were obtained with the administration of dexamethasone monthly, in this way we were able to reach the term of the pregnancy with good results for mother and neonate. The importance of early diagnosis is imperative and initiating the adequate treatment that according to our results would be dexamethasone pulses; the use of hyperimmune gammaglobulin in restricted due to high cost, and the platelets transfusion would be indicated only in cases of severe thrombocythopenia, imminence of hemorrhage or if a surgical procedure has to be done. An extensive review of the literature is done.