Introduction
When there is a risk for a non-pregnancy etiology or an extremely low platelet count for the blood abundance-related (blood contents) challenges of delivery, hematologists are frequently consulted for thrombocytopenia during pregnancy. Counseling regarding the safety and effectiveness of various medications during pregnancy should be provided to patients with chronic low platelet conditions. There is a need for more research into how to treat pregnant women with chronic immune thrombocytopenia not responding to first-line treatments.
Thrombocytopenia occurs in up to 10 percent of pregnancies, with causes ranging from benign to life-threatening. In patients who already have chronic thrombocytopenia, treatment recommendations are also made by hematologists.
What Are Platelets?
Platelets are tiny cells that are tracked down in the blood. Their function is to stop bleeding. The platelets become sticky and clump together to form a blood clot at the injured area when a blood vessel is damaged, halting the bleeding.
Assuming the platelet count is low, and there is a lack of an adequate number of platelets in the blood to cease bleeding. Even without trauma, bleeding can start if the platelets are low. A low platelet consider is likewise known as 'thrombocytopenia'.
What Does It Mean to Have Low Platelets During Pregnancy?
Around 20 percent of individuals who are pregnant have low platelets. More often than not, this does not create complications, albeit the probability of complexities relies upon the etiology and the severity of low platelet count. If the low platelet levels are present during the pregnancy, the doctor or midwife will arrange for frequent blood tests to monitor them.
What Causes Pregnant Women to Have Low Platelet Levels?
There are a wide range of reasons for low platelets. Some can happen at any time, while others only happen during pregnancy.
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Gestational Thrombocytopenia-
This represents a low platelet count brought about by the ordinary changes of pregnancy. It is the most common reason for pregnant women to have low platelet levels. It is generally gentle and disappears after the child is delivered. It rarely poses a threat to either the mother or the infant.
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Immune Thrombocytopenia (ITP)-
It is an autoimmune condition in which the body produces antibodies that damage platelets. It can occur at any point in time. However, it can deteriorate during pregnancy. It can cause exceptionally low platelets, which might seriously endanger the mother and the child of dying.
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HELLP Disorder-
This is a significant pregnancy threat that can develop, assuming the presence of pre-eclampsia (high blood pressure disorder that can occur during pregnancy). It may result in other blood and liver issues as well as extremely low platelet count.
Other possibilities for low platelets include:
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Viruses.
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Insufficient vitamin B12 or folate intake.
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Certain medications that reduce platelet count.
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Autoimmune conditions.
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Issues with the liver or spleen are all potential causes of low platelets.
What Are the Symptoms of Low Platelets?
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Wounds that show up on the skin with no injury.
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Draining/bleeding from the nose and mouth.
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It requires a long time for the draining/bleeding to stop after a cut or injury.
How Is a Low Platelet Count Analyzed?
A full blood count (FBC) or full blood examination (FBE) is used to diagnose a low platelet count. This blood test will be provided by the doctor or midwife as part of the regular antenatal exams at 26 to 28 weeks and at the beginning of the pregnancy. If the platelets are low, the doctor could have further blood tests to search for the etiology.
What Are the Threats of Low Platelets During Pregnancy and Birth?
A low platelet count may increase the odds of having a postpartum hemorrhage and draining/bleeding around the spinal cord, assuming that the patient is under an epidural or spinal sedative. This is not normally a worry if the platelets are just somewhat low.
The baby may also have low platelets if the mother has immune thrombocytopenia (ITP). This builds the child's odds of bleeding, particularly in the event that they are born with a ventouse or forceps delivery.
What Treatments Are Available for Low Platelet Counts During Pregnancy and Birth?
In pregnancy, thrombocytopenia typically does not prompt an expanded threat of dying. The risk of bleeding remains low even in patients with ITP, where thrombocytopenia is frequently quite severe. The method of delivery is determined by the obstetric indication. The lower risk of bleeding makes vaginal delivery preferable from a hematologic standpoint.
Treatment is not required if the platelet count is only slightly low; however, additional blood tests will be required for monitoring.
In the presence of immune thrombocytopenia (ITP) or very low platelet counts, refer to a hematologist or a specialist in blood disorders. Assuming the platelet count is exceptionally low, the maternity specialist will suggest conceiving an offspring in an emergency clinic where a blood donation center is accessible 24 hours per day. They will also talk about whether epidural anesthesia is a safe way to get rid of pain for the delivery and treatment to increase the platelet count.
There are a few medicines to expand the platelet count, including:
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Steroid medication.
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Intravenous immunoglobulin is a dose of antibodies injected into the vein.
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Platelet transfusion.
In general, there is no evidence that low platelets can be prevented. In spite of the fact that there are a few things that can help the well-being during pregnancy, for example,
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Consuming folate (vitamin B9) and vitamin B12 in the diet.
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Avoiding medications that can affect the platelets.
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Abstaining from activities that risk contracting hepatitis C or HIV.
Complications-
Thrombocytopenia during pregnancy rarely results in bleeding during pregnancy, even when very low platelet counts are observed. These complications are secondary to the underlying cause.
Conclusion
Even though most pregnant women experience thrombocytopenia, it should be thoroughly investigated. Patients need to be assured that the diagnosis is benign in the case of gestational thrombocytopenia. As soon as possible, patients and their families should receive appropriate education and begin receiving appropriate treatment aimed at the underlying cause. Patients ought to be followed for platelet counts every two to four weeks to notice a pattern in their platelet counts. Patients and relatives ought to grasp that the delivery method (vaginal or cesarean segment) will be concluded in view of obstetric (relating to childbirth and the processes associated with it)signs and not the platelet count. Patients should also be aware that platelet transfusions are not a common treatment for pregnant thrombocytopenia. If a pregnant woman has thrombocytopenia and her platelet count falls or if bleeding occurs, an experienced hematologist should be consulted.
