Gestational thrombocytopenia is the most common cause of thrombocytopenia during pregnancy (70%), but other underlying causes must be considered as well.
A thorough history and physical examination is important to rule out most other causes.
Look at the remainder of CBC and smear to rule out pancytopenia and platelet clumping associated with pseudothrombocytopenia.
If no antecedent history of thrombocytopenia is present and platelet counts are >70,000/μL, the condition is more likely to be GT.
If platelet counts fall to < 50,000/μL or if a preexisting history of thrombocytopenia is present, the condition is more likely to be ITP.
Direct or circulating antiplatelet antibodies has no value in the workup of thrombocytopenia in pregnancy because they usually are nonspecific and will not distinguish GT from ITP.
Cesarean deliveries for ITP or GT should be reserved for obstetrical indications only because vaginal delivery itself has not been demonstrated to be a cause for intracranial hemorrhage.
Invasive procedures to determine fetal platelet counts (scalp sampling, PUBS) are no longer considered necessary for ITP, because an infant who is thrombocytopenic may be delivered vaginally. However, PUBS may still be of value in alloimmune thrombocytopenia to assess the severity of the condition and therapeutic response.
With ITP, obtain cord blood at delivery (if possible) for platelet count and notify the pediatricians to assess neonatal platelet counts due to the risk for continued quantitative platelet decline and postnatal hemorrhage.
For GT, document normalization of maternal platelet counts after delivery.
Gestational thrombocytopenia is the most common cause of thrombocytopenia during pregnancy (70%), but other underlying causes must be considered as well.A thorough history and physical examination is important to rule out most other causes.Look at the remainder of CBC and smear to rule out pancytopenia and platelet clumping associated with pseudothrombocytopenia.If no antecedent history of thrombocytopenia is present and platelet counts are >70,000/μL, the condition is more likely to be GT.If platelet counts fall to < 50,000/μL or if a preexisting history of thrombocytopenia is present, the condition is more likely to be ITP.Direct or circulating antiplatelet antibodies has no value in the workup of thrombocytopenia in pregnancy because they usually are nonspecific and will not distinguish GT from ITP.Cesarean deliveries for ITP or GT should be reserved for obstetrical indications only because vaginal delivery itself has not been demonstrated to be a cause for intracranial hemorrhage.Invasive procedures to determine fetal platelet counts (scalp sampling, PUBS) are no longer considered necessary for ITP, because an infant who is thrombocytopenic may be delivered vaginally. However, PUBS may still be of value in alloimmune thrombocytopenia to assess the severity of the condition and therapeutic response.With ITP, obtain cord blood at delivery (if possible) for platelet count and notify the pediatricians to assess neonatal platelet counts due to the risk for continued quantitative platelet decline and postnatal hemorrhage.For GT, document normalization of maternal platelet counts after delivery.
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