Case 109 – update 4

Thanks for your help so far. The lady thankfully had an uneventful normal vaginal delivery. She had chance to have an anaesthetics review prior to labour and had been attending joint obstetric and haematology clinic. Her pre prepared birth plan included the following points:

Mode of delivery based solely on obstetric indications.

Delivery should ideally be in a hospital with Haematology and obstetric care.

Target platelet count >50×10^9/L for vaginal and operative delivery.

For epidural anaesthesia platelet count needs to be >80×10^9/L.

Platelet transfusions should be available in case of complications.

Haematology team to be contacted if any concerns regarding platelet count or bleeding.

Neonates born to mothers who have ITP do have a risk of thrombocytopenia due to passage of Ig G Ab across the placenta. 

15-30% of babies born to mothers with ITP are thrombocytopenic. All babies born to mothers with presumed ITP should be treated as possibly being thrombocytopenic. When writing birth plans and the following points need to be communicated to obstetric and paediatric team as happened in this case.

Foetal scalp electrodes and instrumental deliveries are ideally avoided.

Cord blood should be taken at delivery to confirm the platelet count.

IM vitamin K should also be avoided.

If platelets less than 50×10^9/L on cord blood or symptomatic transcranial USS should be performed.

Our lady had a healthy baby boy with a normal platelet count of 370×10^9/l on cord blood sampling.

Does the baby require any further platelet count monitoring? If so when would you check platelet count again?

The lady is keen to know of the implications of her ITP on future pregnancies, how likely is she to need treatment for ITP in further pregnancies?

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