Thrombocytopenic Purpura in Pregnancy; Treatment by Splenectomy and Cesarean Section

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Inasmuch as thrombocytopenic purpura is an uncommon disease, its occurrence in pregnancy is even more rare. Since the description of essential purpura by Werlhof in 1775, numerous contributions toward its etiology, diagnosis, and treatment have been made, including the first splenectomy by Schloffer in 1916.

The coexistence of thrombocytopenic purpura and pregnancy has been less widely reported. Polowe in 1944 reviewed the literature and found 62 cases of pregnancy complicated by purpura. However, in 1943 Burnett and Klass found records of 68 cases of which they regarded only 4 as true thrombocytopenic purpura. Finn in 1944 accepted the cases of Burnett and Klass, gleaned 6 more from the literature, and described 3 cases of his own, thus bringing the total to 13 cases. Patterson has recently reported another case. Since an accurate analysis of all reported cases is impossible, and since there are doubtless other unreported cases, it may, nevertheless, be safely assumed that thrombocytopenic purpura in pregnancy is one of medicine’s more unusual combinations.

Splenectomy has been performed in a moderate percentage of cases of pregnancy complicated by thrombopenic purpura. As in uncomplicated purpura, the procedure has been followed largely by dramatic improvement. If one is to accept the total number of proved cases of thrombopenic purpura in pregnancy as being in the neighborhood of 15, a study of these cases reveals splenectomy to have been performed in 8.

A careful analysis of the literature has failed to reveal a case of pregnancy complicated by thrombocytopenic purpura in which. . .



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