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Thrombocytopenia in Pregnant Women
Obstet Gynecol; ePub 2016 Sep; ACOG Comm on Prac Bulletins -
Obstetrics
September 5, 2016
The American College of Obstetricians
and Gynecologists (ACOG) has issued a practice bulletin on
thrombocytopenia in pregnant women, offering clinical
considerations and recommendations. They include:
• Maternal thrombocytopenia between 100
x 109/L and 149 x 109/L in asymptomatic pregnant women with
no history of bleeding problems is usually due to
gestational thrombocytopenia.
• Given the very low risk of serious
neonatal hemorrhage, the mode of delivery in pregnancies
complicated with ITP should be determined based upon
obstetric considerations alone.
• In pregnancies defined as “high risk”
of intracranial hemorrhage (fetal platelet counts by
umbilical cord blood sampling at 20 weeks of gestation of
less than 20 x 109/L or a sibling with a perinatal
intracranial hemorrhage), maternal IVIG combined with
prednisone is more effective than IVIG alone in eliciting a
satisfactory fetal platelet response. Whereas in “standard
risk” pregnancies (no history of intracranial hemorrhage in
a previously affected sibling and initial fetal platelet
counts greater than 20 x 109/L at 20 weeks of gestation),
IVIG or prednisone therapy is beneficial, with no
significant advantage of one therapy over another.
• Consensus guidelines recommend
platelet transfusion to increase the maternal platelet count
to more than 50 x 109/L before major surgery.
• Epidural or spinal anesthesia is
considered acceptable in patients with platelet counts
greater than or equal to 80 x 109/L provided that the
platelet level is stable, there is no other acquired or
congenital coagulopathy, the platelet function is normal,
and the patient is not on any antiplatelet or anticoagulant
therapy.
• Fetal–neonatal alloimmune
thrombocytopenia should be suspected in cases of otherwise
unexplained fetal or neonatal thrombocytopenia, hemorrhage,
or ultrasonographic findings consistent with intracranial
bleeding.
Citation: American College of
Obstetricians and Gynecologists. Thrombocytopenia in
pregnancy. Practice Bulletin No. 166. Obstet Gynecol.
2016;128:e43–53.
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