Pregnancy complicated by thrombocytopenia secondary to human immunodeficiency virus infection.

Abstract

Human immunodeficiency virus (HIV)-positive pregnant women may manifest thrombocytopenia similar to that of immune thrombocytopenic purpura (ITP), putting the fetus at risk of thrombocytopenia and hemorrhage. Whereas the fetal platelet count can be assessed in cases of ITP, there is no safe way to evaluate it during HIV-positive pregnancy without risking fetal inoculation with HIV. A pregnant woman with HIV-associated autoimmune thrombocytopenia was treated on several occasions with immune globulin and prednisone. Because of the inability to assess the fetal platelet count owing to the risk of fetal inoculation with maternal HIV, a primary cesarean was performed at term. The neonate was thrombocytopenic at birth. Because of the risk of fetal thrombocytopenia and the inability to evaluate fetal platelet counts safely (without resorting to invasive procedures that may increase the risk of fetal HIV infection), women with HIV-associated autoimmune thrombocytopenia should be delivered by cesarean.