Fetal Hydrocephalus following Intracranial Hemorrhage secondary to Maternal Idiopathic Thrombocytopenic Purpura : A Case Report

Abstract

Idiopathic thrombocytopenic purpura (ITP) is the most common autoimmune disease in women of childbearing age group. Although maternal antiplatelet antibodies might cross the placenta, they usually do not cause severe bleeding disturbances in the fetus. Occurrence of fetal intracranial hemorrhage is extremely uncommon. We report a case of a fetus developed intracranial hemorrhage at 34 weeks of gestational age, possibly secondary to maternal ITP. The hemorrhage was intra and periventricular, with the development of posthemorrhagic hydrocephalus. Cesarean section was performed at 35 weeks of gestation because of progression of hydrocephalus. In order to control hydrocephalus, Ommaya's reservoir was placed in the right anterior horn three days after birth, considering the poor general condition of the infant girl. Her level of consciousness suddenly decreased the following day. CT scan showed recurrence of intraventricular hemorrhage. She underwent platelet transfusion and repeated aspiration of bloody cerebrospinal fluid from the reservoir. Following this, her platelet count normalized gradually. Ventriculoperitoneal shunt was carried out successfully 2 months after birth. Thereafter she did not experience any hemorrhagic episodes. The problem of ITP of the mother in relation to pregnancy and its effects on the fetus and the newborn infant are discussed in the present report.