Despite its intimidating name, thrombocytopenia can affect pregnant people and non-pregnant people alike and has only a few implications for pregnancies with additional risk factors for things like post-partum hemorrhage and excessive bleeding. Many people safely deliver even with low platelet counts, even though about 5% of people who deliver healthy babies may have thrombocytopenia. Here’s what low platelets mean and the impact they can have on your delivery plan.
Platelets are a component of blood, in addition to red blood cells and plasma, which help your blood clot when you have an injury – everything from a knee scrape to surgery. Normal platelet counts typically fall in the range of 150,000 to 450,000 per microliter of blood, with thrombocytopenia (low platelet count) being anything below 150,000 (150 for short).
Platelet count is a vital sign that your obstetrician will be paying attention to as it comes time to deliver your baby. Even a measure below 150 on your lab report may not be cause for alarm, as other factors, such as clumping together of platelets that can sneak past a machine analysis, can alter the apparent platelet count and cause undue panic in mothers. Thrombocytopenia is a relatively common occurrence toward delivery and is usually nothing to worry about.
There are a few possible diagnoses that a low platelet count can require: According to Dr. Nathan Fox in a recent Healthful Woman podcast about the topic, “If someone has a platelet count that’s under 50, we’re not going to call it gestational thrombocytopenia.” Instead, he said, it would be classified as idiopathic thrombocytopenia purpura (ITP), which we’ll mention later. “But when they sort of never get below 100 or 90 or 80, it does not tend to have any actual consequences health-wise for her or the baby or the delivery or anything like that.”
More rare causes of low platelets are more serious, including ITP. ITP is an immune disorder that develops when a person’s body begins attacking its own platelets because it thinks they are foreign pathogens. ITP is associated with lupus, thyroid conditions, or rheumatoid arthritis, and if any of these conditions apply to you, your OBGYN team will know about them well in advance of developing serious symptoms.
Whether gestational thrombocytopenia and ITP are distinct conditions or the same one but with different severities is not currently known. The platelet count can be determined regardless. Even if it’s low, as long as it’s not extremely low, mothers have a good chance of delivering without complications due to the platelet count.
One of the complicating factors of having mild or gestational thrombocytopenia is whether you’re eligible for an epidural. Typically when doctors are watching your platelet count, they’re weighing the mother’s options for delivery scenarios. Platelets usually don’t matter unless they’re extremely low when deciding between vaginal birth and C-section, so the major question becomes: is it safe to use an epidural injection if platelet counts are down?
In some cases, yes. However, this is ultimately up to the anesthesiologist who will be placing the needle in a very precise location in a very important part of the body, the spine. And because when the epidural is placed, the anesthesiologist is doing it by feel, not by sight, it can be hard to know if there’s excess or internal bleeding due to the lack of clotting factors in the blood.
There’s no specific number for cutting off the option for an epidural; it’s simply a decision made considering all the physicians’ data and the patient’s delivery preferences. Dr. Fox summarizes that this is still a rarely difficult decision, as “in our hospital, if the number’s above 100,000, pretty much every anesthesiologist is comfortable putting in an epidural.”
During routine pregnancy care appointments, our OBGYNs regularly do blood tests to check your progress and look for early signs of complications like thrombocytopenia. In some cases, we detect low platelet counts early, or descending platelet counts as we approach the delivery date. When this happens, we might refer a patient to a hematologist (blood specialist) who may recommend various treatments like steroids or intravenous immunoglobulin, but these are usually reserved for the more high-risk cases of ITP.
Otherwise, if your platelets are, again, in that middle 80,000 to 100,000 range, even if it’s considered low platelets, very few mothers are at serious risk for adverse events during delivery. If your platelet count is steadily declining, we might schedule a date to induce labor to make sure the platelets will be as normal as possible to ensure all potential treatment paths are on the table.
Your platelet count is just one of dozens of factors that play into your pregnancy care plan and delivery routine. Knowing your risks and options well in advance with a comprehensive care team like the obstetricians and maternal fetal medicine specialists at MFM Associates can help you feel relaxed and confident. Call or contact us today to set up your appointment or schedule a time for preconception counseling.
Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!