Table 1.

How we manage pregnancy in myeloproliferative disease (MPD).

* Severe pregnancy complications: ≥ 3 first-trimester or ≥ 1 second or third-trimester losses, birth weight < 5th centile of gestation, pre-eclampsia, intrauterine death or stillbirth. 

  1. Risk stratification

    At least one of the following defines high-risk pregnancy:

    • - previous major thrombotic or bleeding complication

    • - previous severe pregnancy complications*

    • - platelet count > 1500 × 109/L

  2. Therapy

    • Low-risk pregnancy

      • - Target hematocrit should be kept below 45%

      • - Aspirin 100 mg/day

      • - Low-molecular-weight heparin (LMWH) 4000 U/day after delivery until 6 weeks postpartum

    • High-risk pregnancy

      As above, plus

      • - If previous major thrombosis or severe pregnancy complications: LMWH throughout pregnancy (stop aspirin if bleeding complications)

      • - If platelet count > 1500 × 109/L: consider interferon (IFN)-α

      • - If previous major bleeding: avoid aspirin and consider IFN-α to reduce thrombocytosis

 
* Severe pregnancy complications: ≥ 3 first-trimester or ≥ 1 second or third-trimester losses, birth weight < 5th centile of gestation, pre-eclampsia, intrauterine death or stillbirth. 

  1. Risk stratification

    At least one of the following defines high-risk pregnancy:

    • - previous major thrombotic or bleeding complication

    • - previous severe pregnancy complications*

    • - platelet count > 1500 × 109/L

  2. Therapy

    • Low-risk pregnancy

      • - Target hematocrit should be kept below 45%

      • - Aspirin 100 mg/day

      • - Low-molecular-weight heparin (LMWH) 4000 U/day after delivery until 6 weeks postpartum

    • High-risk pregnancy

      As above, plus

      • - If previous major thrombosis or severe pregnancy complications: LMWH throughout pregnancy (stop aspirin if bleeding complications)

      • - If platelet count > 1500 × 109/L: consider interferon (IFN)-α

      • - If previous major bleeding: avoid aspirin and consider IFN-α to reduce thrombocytosis

 
View Large