Idiopathic Thrombocytopenic Purpura in Pregnant Women: Diagnostic Challenges and Clinical Management During Pregnancy

• DOI: https://doi.org/10.22533/at.ed.51572112601063

• Palavras-chave: idiopathic thrombocytopenic purpura; pregnancy; thrombocytopenia; high-risk pregnancy; obstetric hematology.

• Keywords: idiopathic thrombocytopenic purpura; pregnancy; thrombocytopenia; high-risk pregnancy; obstetric hematology.

• Abstract:

  Idiopathic thrombocytopenic purpura (ITP), now referred to as immune thrombocytopenic purpura, is an autoimmune disease characterized by autoantibody-mediated peripheral destruction of platelets, leading to isolated thrombocytopenia. During pregnancy, ITP poses a significant clinical challenge due to associated maternal and fetal risks, including bleeding, obstetric complications, and neonatal thrombocytopenia. Diagnosis is primarily made by exclusion, and it is essential to differentiate it from other causes of gestational thrombocytopenia, such as preeclampsia, HELLP syndrome, and benign gestational thrombocytopenia. The objective of this study was to review the scientific literature on ITP in pregnant women, emphasizing pathophysiological, diagnostic, therapeutic, and prognostic aspects. This is a narrative review of the literature conducted in the PubMed, SciELO, and Google Scholar databases, using articles published between 2014 and 2025 in Portuguese and English. The results demonstrate that the management of ITP during pregnancy should be individualized, taking into account platelet counts, the presence of bleeding, and gestational age. Corticosteroids and intravenous immunoglobulin remain first-line therapies, while immunosuppressive agents and splenectomy are reserved for refractory cases. It is concluded that multidisciplinary care is essential for reducing maternal-fetal morbidity and mortality and for ensuring better obstetric outcomes.