Boothman L Platelets in pregnancy: Their role and function in disease. British Journal of Midwifery. 2016; 24:(8)550-5

British Committee for Standards in Haematology. 2012. (accessed 14 October 2016)

London: DH; 2010

Cines DB, Bussel JB, Liebman HA, Prak ETL The ITP syndrome: Pathogenic and clinical diversity. Blood. 2009; 113:(26)6511-21

Despotovic J, Lambert MP, Herman J RhIG for the treatment of immune thrombocytopenia: consensus and controversy. Transfusion. 2012; 52:(5)1126-36

European Group for Blood and Marrow Transplantation. 2011. (accessed 14 October 2016)

Fogarty PF, Segal JB The epidemiology of immune thrombocytopenic purpura. Curr Opin Hematol. 2007; 14:(5)515-9

Fogarty PF, Tarantino MD, Brainsky A, Signorovitch J, Grotzinger KM Selective validation of the WHO Bleeding Scale in patients with chronic immune thrombocytopenia. Curr Med Res Opin. 2012; 28:(1)79-87

Gernsheimer T Thrombocytopenia in pregnancy: is this immune thrombocytopenia or…?. Hematology Am Soc Hematol Educ Program. 2012; 2012:198-202

Gernsheimer T, James AH, Stasi R How I treat thrombocytopenia in pregnancy. Blood. 2013; 121:38-47

Kappler S, Ronan-Bentle S, Graham A Thrombotic microangiopathies. Emerg Med Clin North Am. 2014; 3:(32)649-71

Kirkup BLondon: The Stationery Office; 2015

Kistanguri G, McCrae KR Immune thrombocytopenia. Hematology/oncology Clinics of North America. 2013; 27:(3)495-520

Kühne T, Berchtold W, Michaels LA, Wu R, Donato H, Espina B Intercontinental Cooperative ITP Study Group. Newly diagnosed immune thrombocytopenia in children and adults: A comparative prospective observational registry of the Intercontinental Cooperative Immune Thrombocytopenia Study Group. Haematologica. 2011; 96:(12)1831-7

Lefkou E, Hunt BJ Bleeding Disorders in Pregnancy. Obstetrics, Gynaecology and Reproductive Medicine. 2015; 11:(25)314-20

Liu D, Ahmet A, Ward L, Krishnamoorthy P A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013; 9:(1)

Martí-Carvajal AJ, Peña-Martí GE, Comunián-Carrasco G Medical treatments for idiopathic thrombocytopenic purpura during pregnancy. Cochrane Database Syst Rev. 2009; 2

Mebius RE, Kraal G Structure and function of the spleen. Nature Reviews Immunology. 2005; 5:(8)606-16

McCrae K Immune thrombocytopenia: No longer ‘idiopathic’. Cleve Clin J Med. 2011; 78:(6)358-73

Myers B Diagnosis and management of maternal thrombocytopenia in pregnancy. Br J Haematol. 2012; 158:3-15

London: NICE; 2008

National Maternity Review. 2016. (accessed 14 October 2016)

National Patient Safety Agency. 2006. (accessed 14 October 2016)

NHS Choices. Can I take ibuprofen when I'm pregnant?. 2016. (accessed 14 October 2016)

Nicolescu A, Vladareanu AM, Voican I, Onisai M, Vladareanu R Therapeutic options for immune thrombocytopenia (ITP) during pregnancy. Maedica (Buchar). 2013; 8:(2)182-8

London: NMC; 2012

London: NMC; 2015

Parnas M, Sheiner E, Shoham-Vardi I Moderate to severe thrombocytopenia during pregnancy. Eur J Obstet Gynecol Reprod Biol. 2006; 128:(1–022)163-8

Provan D, Stasi R, Newland AC International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010; 115:(2)168-86

Rodeghiero F, Stasi R, Gernsheimer T Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009; 113:(11)2386-93

Roytowski D, Figaji A Raised intracranial pressure:What it is and how to recognise it. CME. 2013; 3:(31)85-90

Semple JW, Provan D, Garvey MB, Freedman J Recent progress in understanding the pathogenesis of immune thrombocytopenia. Current opinion in hematology. 2010; 17:(6)590-95

Stasi R Pathophysiology and therapeutic options in primary immune thrombocytopenia. Blood Transfusion. 2011; 9:(3)262-73

Stavrou E, McCrae KR Immune thrombocytopenia in pregnancy. Hematol Oncol Clin N Am. 2009; 23:(6)1299-316

Sukenik-Halevy R, Fejgin M Management of Immune Thrombocytopenic Purpura in Pregnancy. Obstetrical & Gynecological Survey. 2008; 63:(3)182-8

Suri V, Aggarwal N, Saxena S, Malhotra P, Varma S Maternal and perinatal outcome in idiopathic thrombocytopenic purpura (ITP) with pregnancy. Acta obstetricia et gynecologica Scandinavica. 2006; 85:(12)1430-5

Tarantino MD, Young G, Bertolone SJ Single dose of anti-D immune globulin at 75 microg/kg is as effective as intravenous immune globulin at rapidly raising the platelet count in newly diagnosed immune thrombocytopenic purpura in children. J Pediatr. 2006; 148:(4)489-94

Terrell DR, Beebe LA, Vesely SK, Neas BR, Segal JB, George JN The incidence of immune thrombocytopenic purpura in children and adults: A critical review of published reports. Am J Hematol. 2010; 85:(3)174-80

van Veen JJ, Nokes TJ, Makris M The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals. Br J Haematol. 2010; 148:(1)15-25

Immune thrombocytopaenia in pregnancy: Key principles for the midwife

02 November 2016
9 min read
Volume 24 · Issue 11


Midwives are professionally accountable for detecting deviations from the norm in pregnancy, and initiating referral to an appropriate practitioner. They must work across professional boundaries, particularly where complex conditions require the involvement of doctors, such as immune thrombocytopaenia (ITP) in pregnancy. Most pregnant women with ITP have good outcomes, with only a few requiring first-line treatment. However, close monitoring of maternal and fetal wellbeing are required and appropriate management is crucial in reducing the risk of associated complications.

Midwives are experts in the care of normal pregnancy/birth, but are also professionally accountable for detecting deviations and initiating immediate referral to an appropriate expert (Nursing and Midwifery Council (NMC), 2012). Although the scope of midwifery practice does not include medical diagnosis, as front-line carers, midwives are well placed to make appropriate assessments regarding the health of pregnant women (Chief Nursing Officers of England, Northern Ireland, Scotland and Wales, 2010). Further, it is essential that midwives build a relationship of trust with women and work in partnership, sharing information and consulting regarding their care (NMC, 2015). Care should be tailor-made, offering choices and a service that delivers personalised and safe care for all women and their babies (National Maternity Review, 2016). Midwives are also required to work across professional boundaries (Kirkup, 2015), especially where complex conditions require the involvement of doctors, such as immune thrombocytopaenia (ITP) in pregnancy. Multidisciplinary working is also key to ensure that women receive the correct treatment, particularly when a pregnancy deviates from the norm and becomes high risk owing to an altered health condition.

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