Namavar Jahromi et al. (55.6%) were terminated by cesarean and 54 (40.6%) had vaginal deliveries. Indications for abdominal de- liveries were fetal distress (n=32, 43.2%), previous cesareans (n=27, 36.5%), abnormal presentations (n=6, 8.1%), active phase arrest (n=4, 5.4%), twin (n=1, 1.4%), prolonged rupture of membranes and not responsive to induction of labor (n=4, 5.4%). Medications that were used for the study group during the admission time were corticosteroids in- cluding prednisolone (n=88, 66.2%), dexamethasone (n=78, 58.6%) and hydrocortisone (n=39, 29.3%). Fourteen women (10.5%) used intravenous immuno- globulin (IVIg), 38 women (28.6%) used at least one kind of medication, 66 (49.6%) used two kinds, 15 (11.3%) used three kinds and for one case (0.8%), 4 types of medications were used simultaneously. There were only 11 women (8.3%) who did not use any kind of medications. Four of them were diagnosed before pregnancy and 7 cases diagnosed during preg- nancy. There were 8 (6%) women known cases of ITP who had splenectomy prior to their pregnancies. Sixty three women (47.4%) received platelet transfu- sion in their hospital course. There were 57 (43.2%) cases who were known cases of ITP before pregnancy and 75 (56.8%) were diagnosed during pregnancy. These two groups were compared. The data was presented in Table 2. The two groups had no statistically significant difference except for NICU admission rate which was higher for the neonates of the women who were known cases of ITP prior to pregnancy (p=0.01). There were two women admitted with intrauterine dead fetuses at 224 and 247 days of pregnancy. They were both known cases of ITP prior to pregnancy. In this study, there were 5 women with bleeding compli- cations who needed blood transfusions. The first was a 28 years old woman with PC=20,000/µL who need- ed emergency cesarean for fetal distress and devel- oped hematoma at the site of spinal needle. The se- cond case had normal delivery with PC=41,000/µL and developed postpartum uterine bleeding and need- ed transfusion. The other 3 cases had cesarean deliv- eries for obstetric indications with PCs of 15,000/µL, 45,000/µL and 70,000/µL and developed hemorrhage during operation. The parturient with platelet count of 70,000/µL needed reoperation for drainage of mas- sive hematomas. There were no maternal mortalities among this study population. Discussion ITP is estimated to occur in 1 in 1000 to 1 in 10 000 pregnant women and is responsible for almost 3% of all cases of thrombocytopenia in pregnancy and con- sidered as a rare condition.6,12 Careful management of ITP during pregnancy may become life saving for the mother and her offspring. Diagnosis of ITP is a diag- nosis of exclusion and should be performed clinically. According to practice guidelines platelets, rarely de- crease to less than 80,000/µL in gestational thrombo- cytopenia.5,6 In this study, if thrombocytopenia pre- sented for the first time during pregnancy, we includ- ed only the cases with PCs less than 80,000/µL. However the cases that were diagnosed prior to preg- nancy were all included. We retrospectively reviewed Table 2: Comparison of maternal and neonatal characteristics of pregnancies complicated by ITP between the cases that were diagnosed before pregnancy with the cases diagnosed during pregnancy. Variable Diagnosed before Diagnosed during P valuec pregnancy (n=58) pregnancy (n=75) Maternal age (year) 26.08±5.09 26.8±4.64 0.416 Maternal PCs (/µL) 64,035±44,941 60,920±33,327 0.648 Gestational age at delivery (days) 264±17.3 267±14.3 0.204 Preterm birth 16 (27.6%) 15 (20%) 0.416 Diabetes 9 (15.5%) 6 (8%) 0.165 Preeclampsia 7 (12.1%) 11 (14.7%) 0.695 Cesarean delivery 35 (60.3%) 39 (52%) 0.348 5 minutes apgar score<7 3 (5.2%) 5 (6.7%) 0.715 Neonatal birth weight (grams) 2915.7±678 2926.6±526.3 0.924 Neonatal PCa (/µL) 135880±58899 153860±62605 0.924 Neonatal PCa<50,000/µL 3 (2.3%) 0 (0.0%) 0.122 Maternal PCa<50,000/µL 25 (43.1%) 31 (41.3%) 0.447 NICUb admission 20 (34.48%) 12 (16%) 0.017 aPC: Platelet Count; bNICU: Neonatal Intensive Care Unit. cValues are presented as mean±SD or number (%). 432 WWW.ircmj.com Vol 14 July 2012