3rd Trimester
gestational thrombocytopenia
I was told at few weeks ago that my blood platelets were really low and that I would not be able to have an epidural at delivery. I am curious if anyone else has delivered with this condition or know much about it. I am so nervous!!!! There is limited amounts of information on the internet and my doctor is waiting to tell me more until after my blood work comes back again. But, if my counts come back too low then they will induce next week. TIA!!!
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Re: gestational thrombocytopenia
I'm bored and lurking
I had low platelets during pg too. What are your counts? Mine were hovering just above 100 which is where they draw the line for epidurals. I went to a practice with about 6 doctors and one that I saw gave me some steroids and said that if they did the trick, they'd talk induction (I was at 38 weeks when they gave me the steroids and 39 when they talked induction). They did work but when I went back, I saw a different doctor who said they may or may not have worked. Apparently your platelet counts vary throughout the day so it could have been a fluke. Besides being annoyed that the other dr. didn't tell me that, I was looking forward to an end.
In the end, I chose an elective induction - with my doctor's blessing. I was advanced maternal age and he gets nervous when AMA moms go past 40 weeks so he was OK doing the induction at 39 weeks.
When I got to the hospital to be induced, my platelets were at 95. My dr. suggested I get the epidural immediately because once they start giving me fluids, they will drop. So he got the anesthesiologist in my room ASAP and he talked to me about the risks of an epidural and what to look for afterward. Other than the fact that the birth seemed completely backward - it was my decision to induce, my decision to have an epidural before feeling any pain - it went really well.
I was induced with my first at 39 weeks b/c of pre-e and it was a very long 21 hours and 3 1/2 hours of pushing. My second induction was much quicker and in fact they turned off the pitocin about half way through b/c I was contracting on my own and after about 20 minutes of pushing I had him.
Sorry - this is really long but if you have other questions, let me know. If you planned on having an epidural, it can be scary to think that the option is no longer available but there might be some things they can do to get your levels up.
I have it as well. I had it with my first pregnancy with DS and have it this time as well.
Do you know what your levels are? Normally the general cutoff for being able to get an epidural is about 100, but it will really end up being up to your anesthesiologist and how comfortable they are with your levels at the time of delivery. When I had my son, i was at 99....they allowed me to get the epidural, and I had no complications.
If your levels are too low to get an epidural and you end up needing a c-section you will have to be put under general anesthesia. My OB plans to check my levels at 36 weeks to see where they're at....they may decide to give me a platelet transfusion when I do deliver, but she said that fact that they're low isn't a reason to induce.
I have not heard about the steroids. My doctor has not mentioned that there was anything that I could do to change my levels besides deliver the baby. She did mention that if I had to have a csection then I would have to be put under. I have read on the internet that some people have to have a transfusion and then they have an immediate csection.
Thanks for your responses at this point I feel like I'm the only person in the world having to think about this. It's so scary.
I have it with this pregnancy and had it with my DD too, although we didn't find out until I was admitted to be induced. It is not necessarily true that you won't be able to have an epi. It depends on the anesthesiologist. I'm already in the grey area at 112. When I was admitted w/ my DD I was 79. I had an epi. He said if I went much lower than they wouldn't have done it. After I gave birth, they were afraid to take it out because my levels kept dropping. I was down to 59 when I went home. I delivered on Thursday at 6am, I didn't get the epi out until Sat around noon. Everyone was afraid to take it out. Finally the anesthesiologist came and did it himself.
I'm even more fearful of an induction now because of this condition. Pitocin is horrible. Horrible. The contractions go from nothing to extreme pain so quickly. There's no time to work up to it. My dr hasn't said anything about an induction because of the low platelets. Did they say whey they'd induce you because of the low levels? Is it in an effort to let you have an epi? It seems odd to me. I'm not a dr, so take this with a grain of salt. I would hold out as long as possible on an induction unless there's a real medical reason. The pain is extreme w/ a pitocin labor. Plus, if you end up having to have a c-section, they will have to knock you out since you can't have an epi. Your best chances will be to go and deliver naturally. But again, I'm only going by my experience and what my dr has said, so take it with a grain of salt
Definitely do as much research as you can so you can make an informed decision based on what your dr tells you. Don't listen and follow blindly.
People who have chronic ITP (which is low platelets) are on steroids. I had ITP as a kid but it was acute and although my platelet levels have always been on the low end, they've never been a problem for me until pg. I'm just not sure if pg induced thrombocytopenia is somehow different than ITP and maybe that's why they don't regularly prescribe steroids or what. Hopefully your dr. can give you more insight when you talk to them.
ETA: When I went for some blood work about 3-4 months postpartum, my levels were back up to 154 which is on the low end of normal - but at least normal.
My doctor just stated that if my counts have gone down again then she would like for him to come now so that they don't keep dropping. We are going to talk about it again once we get the counts back. Thanks for all of the information. I was surprised that there was not much research out there on this. I greatly appreciate all of the helpful information. Thanks!!
My Dr's won't do steriods either. She said they don't think they do enough to make it worth giving them...that it was also more of long term thing or order to make them go up, if I remember correctly.
I would personally hold out being induced if they only reason they're talking about doing it is so you could possibly get the epi. I was induced with my DS (not for the platelet issue) and it was not fun. If there's no other medical reason, I'd wait it out.
I don't think she wants to induce me for the epi. I already told that I it wasn't necessarily my plan to deliver med free but I'm ok with it. I would rather deal with the pain of delivery and not risk something happening due to bleeding caused by the epi. I think she was just thinking induction if the low levels will effect my health.