HOW Collaborative position paper on thrombocytopenia in pregnancy Obs and Guidelines

HOW Collaborative position paper on the management of thrombocytopenia in pregnancy

Position paper published in ANZJOG Jan 2021.

https://doi.org/10.1111/ajo.13303

Causes


Gestational (70-80%)
Primary immune thrombocytopenia (ITP) (1-2%)
Secondary ITP, eg due to human immunodeficiency virus (HIV), hepatitis C, systemic lupus erythematosus
Congenital
Drug-induced
Type IIb von Willebrand’s disease (VWD)
Antiphospholipid syndrome
Splenic sequestration, eg liver disease, portal hypertension
Bone marrow disorders
Nutritional deficiency, eg vitamin B12/folate
Pregnancy-associated microangiopathy

Preeclampsia/haemolysis, elevated liver enzymes, low platelets syndrome (HELLP)
Thrombotic thrombocytopenic purpura (TTP)
Haemolytic uraemic syndrome (HUS)


Acute fatty liver of pregnancy
Sepsis
DIC
Spurious/Pseudothrombocytopenia (clumping)



Initial investigations (if platelet count 50 for: Vaginal birth, Instrumental, Caesarean, Clexane use
Target platelets >70 for allow regional anaesthesia (spinal is less traumatic than epidural)
Stress steroids in labour: IV hydrocortisone 50 mg Q6H from established labour to 6 hours after birth. For caesarean, give 100 mg IV hydrocortisone at time of anaesthesia, then 6 hours post-birth
Mode of birth: Lack of data to inform instrumental risks. ITP is associated with a small increase in neonatal thrombocytopaenia.



This podcast is not endorsed by RANZCOG/ANZJOG and has no affiliation with RANZCOG/ANZJOG. This podcast does not constitute medical advice and comes with no assurance of accuracy. Amazing cover artwork by Anna Lovisa - Ngā mihi nui!