Pregnant with a Low Platelet Count
Having mild thrombocytopenia or a low platelet count during pregnancy is no a reason to freak out. Actually, it is quite a common occurrence towards the end of any regular pregnancy. In a prospective study of 15,000 consecutive women admitted for labor and delivery documented low platelet counts in 5% of these women. Think of it like this… Two or three ladies from every wedding you have been to will be diagnosed with Gestational Thrombocytopenia at some point.
Following the delivery of the child, the mother’s platelet count will usually normalise within 2 to 12 weeks. If the mother’s platelet count does not normalise quickly, then it may be a signifier of something else.
How do you know it is Gestational Thrombocytopenia and not something worse?
The diagnosis of Gestational Thrombocytopenia is considered if there is no history of preceding thrombocytopenia when you were not pregnant. Gestational Thrombocytopenia patients tend to
- have no previous history of abnormal bleeding.
- have only a mild thrombocytopenia count such as 70 or above.
- develop thrombocytopenia during or after the second trimester.
If these conditions are met, it is predicted that your platelet count would return to normal following delivery and that the newborn infant would have a normal platelet count at birth. There is not specific diagnostic test that can distinguish the difference between gestational thrombocytopenia and mild ITP, which is why follow ups after the baby is born will help to know the exact cause. A lot of it will be an exclusion method. There is alway a chance that you already had ITP but it was not detected until you were testing in relation to your pregnancy. Brenda is one such patient who discovered she had ITP while pregnant. It is rare but it does happen.
Please remember that these are general guidelines only. Discuss everything with your doctor or midwife before making any decisions regarding your health.
Gestational thrombocytopenia can recur but the statistics of recurrence is unknown. If you have had Gestational Thrombocytopenia in the past, your specialists will certainly be looking out for it again. If you have already been diagnosed with ITP then you have a low risk of developing Gestational Thrombocytopenia. In fact, patients with ITP tend to see an increase in their platelet levels after falling pregnant.
Monitoring your platelet count periodically is recommended after delivery. No treatment is specifically necessary for gestational thrombocytopenia. Treatment decisions are made on a case by case basis and vary dramatically between women. Invasive approaches to fetal monitoring (fetal blood sampling) are not indicated or recommended unless platelets fall suddenly.
Labor and delivery
Gestational Thrombocytopenia should not necessarily dictate mode of delivery. Decisions should be determined by obstetric/maternal indications, however the mother might be restricted from participating in low risk birthing centres. Epidural anaesthesia is considered safe when platelet count is over 50,000/μ L however every hospital has different requirements. Historically, anesthesia recommendations were that epidurals should be withheld if platelet counts were under 100,000/μ L.
Regional anesthesia considerations
The presence of a coagulopathy is cited as a specific contraindication to the use of regional anesthesia due to concern for an epidural hematoma, which can result in serious neurologic complications. Only 2 cases of epidural hematoma have been reported in gravidas receiving epidurals in labor (1 patient had gestational hypertension and the lupus anticoagulant, and the other patient had an ependymoma). All other cases of non-pregnant epidural hematomas occurred in women receiving anticoagulants.
Management of Gestational Thrombocytopenia is no different to the approach of managing ITP in all patients – which is to focus on maintaining a healthy platelet count with as little treatment as possible along with regular monitoring and check ups. The most important factor is to make sure that the pregnant woman has a safe platelet count for birth. This can be done a number of ways, though none are 100 percent reliable. ITP and Pregnancy
In the study ITP and Pregnancy, no pathological significance for the mother or fetus is noted. No risk for fetal hemorrage or bleeding complications was observed. Samuels evaluated 162 pregnant women and their infants with thrombocytopenia, 74 with presumed Gestational Thrombocytopenia GT. No infant from a GT gravida had a platelet count lower than 50,000 or adverse bleeding during delivery or afterwards.
Medications & Treatments
You many have been told that you will need to take medications. If you are looking for more information about taking Prednisone while pregnancy, you can read about it here. And if you need to take Prednisone after the delivery and are wondering about taking Immune Suppressants while Breast Feeding.
The worst part about having Gestational Thrombocytopenia or a low platelet count is that no matter how mild the thrombocytopenia is, you will probably be classified as a medium risk pregnancy now.
As a lot of birthing centres, water birth pools and midwife run birthing places are set up to accommodate low risk pregnancies only, you may be restricted from labouring or birthing in these centres. It is not something to be worried about in terms of actually being high risk, it just means that there may be less options available to you now. Things in medicine can be very bureaucratic. You may need to find a midwife who will help you do it your way.
There are so many medical websites clogging up the search results when looking for other stories of Gestational Thrombocytopenia, so we went and found some for you. There is also a lot of chatter on pregnancy forums about Gestational Thrombocytopenia, if you are keen to check those out, otherwise there are blog posts and stories below.
Success stories – Positive stories of birth with a low platelet count.
One Fit Mom wrote an honest and informative blog post about the birth of her first child Oliver with gestational Thrombocytopenia. She writes about the fears that that can cause in some people and how she managed to remain in control and have a natural birth. It is a good read if you are worried, and interestingly, the Gestational Thrombocytopenia did not reoccur for her second child.
One Fit Mom blogged about her experience with Gestational Thrombocytopenia and a low platelet count in the third trimester here. Another woman here, natural birth with a low platelet count and with twins – wow. Mama Nic wrote about her experience with Gestational Thrombocytopenia on her blog Embracing Life. Rachael wrote on her Blog the Mumbling Mommy about how many different things there are to worry about while pregnant, and if it is not one thing, it is another.
ITP and Pregnancy, James N. George M.D & George R. Buchanan M.D printed June 1999, PDF from the ITP Support Association UK
An American Perspective reprinted from: Jun 99 Title: ITP and Pregnancy Authors: James N. George, M.D., Oklahoma City, George R. Buchanan, M.D., Dallas.
Reference for Further reading – Emedicine. Gestational Thrombocytopenia Overview.