Decreased platelets during pregnancy, also known as Gestational Thrombocytopenia is a blood disorder that can affect up to 15% of pregnant. It decreases platelet count below 100,000 / mm3. Early diagnosis is important to treat the mother as soon as possible in order to reduce the effects on the fetus.
Why lower platelets in pregnancy?
The drop in platelets or thrombocytopenia may affect up to 15% of all pregnancies and is the second cause of blood disorder in this population, surpassed only by anemia. We speak of thrombocytopenia when the platelet count drops below 100,000 / mm3.
Origin of decreased platelets or thrombocytopenia
This phenomenon may be related to preesxistentes conditions in women of childbearing age, such as primary immune thrombocytopenia (TIP) and systemic lupus erythematosus (SLE). Also in own pregnancy disorders, they are like Gestational Thrombocytopenia or HELLP syndrome, a disorder own third trimester of pregnancy, often related processes gestosis or hypertension during pregnancy. This syndrome is caused by an alteration of the microvasculature of the patient it produces, among other things, an accelerated destruction of blood cellularity, studying with a disproportionate increase in transaminases, anemia haemolytic type with presence of broken red cells in the study of blood smear called schistocytes. It is a syndrome that represents a hematologic urgency, given the clinical complications that can lead to both mother and fetus.
As mentioned, up to 15% of pregnancies may present with decreased platelet counts. This, physiologically, is more evident in the third quarter of the same, due to a Dilutional mechanism coupled with accelerated platelet destruction by passing through the damaged surface of the placenta. If multiple gestations, decreased platelet counts may be associated with increased production of thrombin which cause accelerated consumption thereof. This is what is called Gestational Thrombocytopenia.
Incidence of Gestational thrombocytopenia and diagnosis
Gestational Thrombocytopenia is considered a benign disorder, which occurs incidentally in 5% of all pregnancies, being the cause of up to 80% of thrombocytopenia that may present during pregnancy. It is diagnosed because the platelet count in blood tests, specifically the blood count, is between 70.000- 110,000 / mm3 in almost 90% of them.
It is imperative, as in any hematologic process, a proper and structured the patient medical history, with particular emphasis on family and personal history of thrombocytopenia, as well as previous pregnancies with thrombocytopenia throughout the development of the. Physical exploration for hemorrhagic lesions in the form of bruising or petechiae is crucial for the diagnostic approach, like finding visceromegalies or enlarged liver or spleen, which can be directed to an underlying haemolytic problem, especially in the third trimester.
From an analytical point of view, both the obstetrician-gynecologist and the hematologist request biochemical or appropriate serological studies and analysis of blood smears by the latter in search of morphological alterations in hematologic series that can give direction to a diagnosis or another.
Keep in mind that diagnosis is performed Gestational Thrombocytopenia discard etiopathologic other processes that can produce platelet decrease during pregnancy.
Gestational Thrombocytopenia Treatment and Prognosis
There is no specific therapeutic indication for pregnant women with Gestational Thrombocytopenia. However, regular monitoring of pregnant women by both the gynecologist and the expert should be Hematology , which depend on the number of platelets present the patient. Natural transvaginal delivery is recommended if other obstetric alterations do not contraindicate. Epidural anesthesia can be safely administered with platelet counts greater than 70,000 / mm3, although everything will depend on the assessment of the anesthetist.
After pregnancy closely monitor platelet counts must be performed to verify whether there has been a spontaneous resolution after childbirth. However, there is a small group of postpartum women in whom Thrombocytopenia can persist and develop an immune thrombocytopenia (TIP).
Similarly it has been observed that in following gestations thrombocytopenia can reach 20% of pregnancies. Although the risk of neonatal thrombocytopenia is considered negligible, it is recommended that monitoring of all infants born to mothers with thrombocytopenia by your pediatrician or neonatologist.