Thrombocytopenia (Low platelets) in pregnancy
Mrs PR, a 32 year old lady in her first pregnancy came to consult me at 8 weeks of pregnancy with an extremely low platelet count. Both she and her husband has been by their doctors warned that this was a very dangerous situation and hence, they were anxious when they first saw me. She had been diagnosed with ITP (Idiopathic thrombocytopenic purpura) since 8-9 years and she had taken numerous therapies for the same.
The platelet count in early pregnancy was 6000 (normal being 200,000 to 400,000 in pregnancy) but she was not bleeding (which is the possible complication of this condition). I reassured them that with good management we can achieve a successful pregnancy without complications to the mother also.
She saw a Haematologist and was started on Prednisolone (steroid tablets) to improve her platelet counts. She responded to this and her platelets were around 20,000 - 30,000 throughout the pregnancy. However, due to the steroids, she also developed Gestational Diabetes which was controlled with the help of our Endocrinologist with insulin injections. Her ultrasound scans showed a normal, healthy fetus with good growth.
She had one episode of vaginal bleeding at 33 weeks and at that time her platelet count was 14,000. Her coagulation profile was normal and there were no uterine contractions.
She was then given Injections Dexamethasone to help fetal lung maturity in view of possible preterm delivery. After an inpatient stay of 7 days during which she underwent intensive fetal monitoring and achieved good blood sugar control, she was delivered on 30.12.2015 at 35 weeks by a planned Caesarean section. Her baby girl weighed 2550gms and was very healthy.
Pre-operatively, she was transfused with 6 units of platelets (RDP) and 6 more units were kept as standby. The operation was uncomplicated and she had a good recovery, with discharge at 6 days. Her baby girl also did very well and was on complete breast-feeding by second day. Both mother and baby are doing well at 6 weeks post-delivery.
Thus, with multidisciplinary management (Feto-maternal Medicine Specialist, Haematologist, Endocrinologist and Anaesthetist), a complex high-risk pregnancy case was handled with a successful outcome.