Gestational Thrombocytopenia

Introduction: Thrombocytopenia in pregnancy is estimated to affect 7–12 percent of pregnancies and is the most common hematological complication seen in pregnancy.¹ This condition can occur at any time during pregnancy, with a peak incidence occurring at the time of delivery. It is often benign, self-limiting, and an incidental finding detected through routine prenatal screening, usually in the 3rd trimester, in mothers who are normotensive, have no prior history of thrombocytopenia or other bleeding disorders, and asymptomatic.

Case Report: A 29-year-old G4P3002 at 39 weeks 1-day gestational age presented to OB triage with signs of labor and meconium-stained amniotic fluid. Prenatal laboratories demonstrated a gestational thrombocytopenia and repeat laboratories on admission showed a platelet count of 61,000/uL with an elevated platelet volume. All other prenatal laboratories were within normal limits and the patient was normotensive with a BP of 127/64. The patient emigrated from Yemen. Her first pregnancy resulted in fetal demise of a full-term infant due to unknown causes. She had two subsequent pregnancies resulting in full term, healthy infants born via C-section. In 2018, her second pregnancy, she was diagnosed with gestational thrombocytopenia and underwent general anesthesia for cesarean delivery. For this current pregnancy, she again underwent repeat cesarean delivery with general anesthesia. Cross-matched platelets were ordered. Following delivery of the fetus, a repeat CBC demonstrated an improved platelet count of 85,000/µL.

Conclusion: It is essential to patient care to work up all pregnant women with thrombocytopenia to determine the underlying cause. While gestational thrombocytopenia is the most common etiology, serious causes that are missed could be detrimental to both the mother and fetus. There are multiple options that have been studied for the treatment and management of gestational thrombocytopenia, with steroids and intravenous immunoglobulin showing the most success. It is also important for a thorough medical history to be obtained as the recurrence rate for gestational thrombocytopenia is fairly high.

Publication History

Article published online:
17 September 2021