Severe Primary Immune Thrombocytopenia (ITP) in Pregnancy
Dr Angharad Care (Clinical Research Fellow) from Liverpool University/Liverpool Women's Hospital was awarded £16,000 by The ITP Support Association to conduct a population-based prospective analysis of all reported cases in the UK of severe primary ITP in pregnancy over 12 months using the UK Obstetric Surveillance System (UKOSS). This is essential research as ITP is more prevalent in women of reproductive age and it may affect both mother and baby. There are currently no good quality clinical trials in this area and this study should: determine the true incidence of severe ITP in pregnant women (number of severe cases in 12 months); describe how cases are managed and; report outcomes for mother and baby.
We are currently in the collection phase of our data. Since June, nationally, there have been 51 reports of ITP in pregnancy and we are continuing to collect every month. The next step is to confirm the cases by sending data collection forms to each unit reporting a case to complete. That way we ensure they meet the case definition/criteria set by this project and obtain a full set of data to analyze for the project. Of 20 data collection forms received so far by the UK Obstetric Surveillance System (UKOSS) there are 13 confirmed cases, 4 do not meet the criteria, 2 have been reported in error and for 1 the reporting unit at present do not have the case notes and therefore cannot report.
The surveillance period is currently set to run until May 2014. We will review the number of cases that we acquire in that time and if we feel that it is insufficient for analysis we would make a plan to continue recruiting for an additional period of time. Ideally a minimum of 100 cases is needed for meaningful analysis.
Dr Angharad Care. Nov 2013
Sept 2014 update by Dr Care
Up to June 2014, 90 cases of ITP in pregnancy have been reported. Information has been received for 74 cases (82%). Of these, fourteen cases were reported in error, one set of case notes was reported lost and 8 did not meet the case definition. Thus, there are currently 51 known confirmed cases in an estimated 800,000 maternities. This gives an estimated incidence of severe ITP in pregnancy in the UK of 6.4 per 100,000 maternities; however, this may be a significant underestimate as data collection is still incomplete. The data collection period has been extended to January 2015.
Dr Care presented the following results of this research in the ITP Support Association 2015 National Convention.
This national cohort study was undertaken by 202 consultant led units between 2013 and 2015. She was assisted by three reporting clinicians from UKOSS.
The summary of the research showed this to be the largest reported cohort of severe ITP in pregnant women. There was a high rate of postpartum haemorrhage and an extremely low maternal and neonatal morbidity level of approx. 1 in 10,000 pregnancies. There was no difference in outcomes between patients treated antenatally or during labour, but it was noted that treatment carried some risks.
Dr Angharad Care
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