18
Treatment
Statement 28
➤ Women with a history of iTTP require close monitoring by a
hematologist with experience in maternal fetal medicine throughout
pregnancy. Their risk of relapse is generally considered to be high
if they enter pregnancy with a plasma ADAMTS13 activity below the
normal range. If ADAMTS13 activity falls significantly (usually <30
IU/dL or 30% of normal), in the absence of clinical relapse, elective
TPE and corticosteroids or azathioprine are often considered.
➤ It is good practice to monitor ADAMTS13 activity throughout
pregnancy and in the postpartum period. Induction of labor at 36 to
37 weeks gestation is commonly suggested. In the absence of other
obstetrical indications for caesarean section, vaginal delivery is
considered the preferred method of delivery in pregnant women with
a history of TTP. This statement also applies to women with a history
of cTTP.
Statement 29
➤ Women with a history of TTP who are planning pregnancy usually
receive preconception counselling. Pregnant women with a history of
TTP have a high risk of serious complications during pregnancy. They
receive plasma infusion, at a dose of 10 to 15 mL/kg weekly or every
two weeks, or TPE, depending on the symptoms. Beginning in the
second or early third trimester, the frequency of infusion is usually
increased to weekly or twice weekly or TPE. Women with a history
of TTP require close monitoring by a hematologist with experience in
maternal fetal medicine throughout pregnancy. Induction of labor at
36 to 37 weeks gestation is commonly suggested. In the absence of
other obstetrical indications for caesarean section, vaginal delivery is
considered the preferred method of delivery in pregnant women with
a history of TTP. These statements apply to women with a history of
either cTTP or iTTP.
Statement 30
➤ We did not systematically search and review the evidence on the
effect of aspirin in pregnant women with TTP. Largely based on
indirect evidence from other populations, pregnant women with a
history of TTP are usually not offered low dose aspirin throughout
pregnancy.
