The patient reported here is the twentieth reported case of thrombotic thrombocytopenia purpura (TTP) occurring in pregnancy, the third survivor, and the first to be delivered by cesarean section. Diagnosis of TTP is usually made on the basis of the pentad of anemia, thrombocytopenia, renal disease, neurologic abnormalities, and fever. A peripheral smear showing microangiopathic hemolysis can be confirmatory and may even be regarded as a definitive test in questionable cases of thrombocytopenia. Although splenectomy, steroids, heparin, and early delivery have been recommended, splenectomy is the only treatment showing a statistically significant improvement in survival rate; 60% of infants born at or beyond 33 weeks' gestation have survived.
(C) 1975 The American College of Obstetricians and Gynecologists