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Antenatal intraveno...
Antenatal intravenous immunoglobulins in pregnancies at risk of fetal and neonatal alloimmune thrombocytopenia : comparison of neonatal outcome in treated and nontreated pregnancies
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- Ernstsen, Siw L. (författare)
- University Hospital of North Norway
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- Ahlen, Maria T. (författare)
- UiT The Arctic University of Norway, Tromsø,University Hospital of North Norway
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- Johansen, Tiril (författare)
- UiT The Arctic University of Norway, Tromsø
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- Bertelsen, Eirin L. (författare)
- UiT The Arctic University of Norway, Tromsø
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- Kjeldsen-Kragh, Jens (författare)
- Lund University,Lunds universitet,Avdelningen för hematologi och transfusionsmedicin,Institutionen för laboratoriemedicin,Medicinska fakulteten,Division of Hematology and Transfusion Medicine,Department of Laboratory Medicine,Faculty of Medicine,University Hospital of North Norway,Regional Laboratories Region Skåne
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- Tiller, Heidi (författare)
- University Hospital of North Norway,UiT The Arctic University of Norway, Tromsø
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(creator_code:org_t)
- Elsevier BV, 2022
- 2022
- Engelska.
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Ingår i: American Journal of Obstetrics and Gynecology. - : Elsevier BV. - 0002-9378. ; 227:3, s. 1-506
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http://dx.doi.org/10... (free)
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Abstract
Ämnesord
Stäng
- Background: Maternal alloantibodies to human platelet antigen-1a can cause severe intracranial hemorrhage in a fetus or newborn. Although never evaluated in placebo-controlled clinical trials, most Western countries use off-label weekly administration of high-dosage intravenous immunoglobulin in all pregnant women with an obstetrical history of fetal and neonatal alloimmune thrombocytopenia. In Norway, antenatal intravenous immunoglobulin is only recommended in pregnancies wherein a previous child had intracranial hemorrhage (high-risk) and is generally not given in other human platelet antigen-1a alloimmunized pregnancies (low-risk). Objective: To compare the frequency of anti-human platelet antigen-1a-induced intracranial hemorrhage in pregnancies at risk treated with intravenous immunoglobulin vs pregnancies not receiving this treatment as a part of a different management program. Study Design: This was a retrospective comparative study where the neonatal outcomes of 71 untreated human platelet antigen-1a-alloimmunized pregnancies in Norway during a 20-year period was compared with 403 intravenous-immunoglobulin-treated pregnancies identified through a recent systematic review. We stratified analyses on the basis of whether the mothers belonged to high- or low-risk pregnancies. Therefore, only women who previously had a child with fetal and neonatal alloimmune thrombocytopenia were included. Results: Two neonates with brain bleeds were identified from 313 treated low-risk pregnancies (0.6%; 95% confidence interval, 0.2–2.3). There were no neonates born with intracranial hemorrhage of 64 nontreated, low-risk mothers (0.0%; 95% confidence interval, 0.0–5.7). Thus, no significant difference was observed in the neonatal outcome between immunoglobulin-treated and untreated low-risk pregnancies. Among high-risk mothers, 5 of 90 neonates from treated pregnancies were diagnosed with intracranial hemorrhage (5.6%; 95% confidence interval, 2.4–12.4) compared with 2 of 7 neonates from nontreated pregnancies (29%; 95% confidence interval, 8.2–64.1; P=.08). Conclusion: The most reliable data hitherto for the evaluation of intravenous immunoglobulins treatment in low-risk pregnancies is shown herein. We did not find evidence that omitting antenatal intravenous immunoglobulin treatment in low-risk pregnancies increases the risk of neonatal intracranial hemorrhage.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)
Nyckelord
- alloimmunization
- antenatal management
- human platelet antigen 1a
- intracranial hemorrhage
- intravenous immunoglobulins
- neonatal alloimmune thrombocytopenia
- newborn
Publikations- och innehållstyp
- art (ämneskategori)
- ref (ämneskategori)
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