Fetal intracranial haemorrhages caused by fetal and neonatal alloimmune thrombocytopenia: an observational cohort study of 43 cases from an international …
H Tiller, MM Kamphuis, O Flodmark… - BMJ open, 2013 - bmjopen.bmj.com
BMJ open, 2013•bmjopen.bmj.com
Objective To characterise pregnancies where the fetus or neonate was diagnosed with fetal
and neonatal alloimmune thrombocytopenia (FNAIT) and suffered from intracranial
haemorrhage (ICH), with special focus on time of bleeding onset. Design Observational
cohort study of all recorded cases of ICH caused by FNAIT from the international No
IntraCranial Haemorrhage (NOICH) registry during the period 2001–2010. Setting 13 tertiary
referral centres from nine countries across the world. Participants 37 mothers and 43 …
and neonatal alloimmune thrombocytopenia (FNAIT) and suffered from intracranial
haemorrhage (ICH), with special focus on time of bleeding onset. Design Observational
cohort study of all recorded cases of ICH caused by FNAIT from the international No
IntraCranial Haemorrhage (NOICH) registry during the period 2001–2010. Setting 13 tertiary
referral centres from nine countries across the world. Participants 37 mothers and 43 …
Objective
To characterise pregnancies where the fetus or neonate was diagnosed with fetal and neonatal alloimmune thrombocytopenia (FNAIT) and suffered from intracranial haemorrhage (ICH), with special focus on time of bleeding onset.
Design
Observational cohort study of all recorded cases of ICH caused by FNAIT from the international No IntraCranial Haemorrhage (NOICH) registry during the period 2001–2010.
Setting
13 tertiary referral centres from nine countries across the world.
Participants
37 mothers and 43 children of FNAIT pregnancies complicated by fetal or neonatal ICH identified from the NOICH registry was included if FNAIT diagnosis and ICH was confirmed.
Primary and secondary outcome measures
Gestational age at onset of ICH, type of ICH and clinical outcome of ICH were the primary outcome measures. General maternal and neonatal characteristics of pregnancies complicated by fetal/neonatal ICH were secondary outcome measures.
Results
From a total of 592 FNAIT cases in the registry, 43 confirmed cases of ICH due to FNAIT were included in the study. The majority of bleedings (23/43, 54%) occurred before 28 gestational weeks and often affected the first born child (27/43, 63%). One-third (35%) of the children died within 4 days after delivery. 23 (53%) children survived with severe neurological disabilities and only 5 (12%) were alive and well at time of discharge. Antenatal treatment was not given in most (91%) cases of fetal/neonatal ICH.
Conclusions
ICH caused by FNAIT often occurs during second trimester and the clinical outcome is poor. In order to prevent ICH caused by FNAIT, at-risk pregnancies must be identified and prevention and/or interventions should start early in the second trimester.
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