ITP and Pregnancy: Precautions and Care
Idiopathic Thrombocytopenic Purpura (ITP) is a condition which causes a drastic reduction of the platelets in your blood. Insufficient platelets in your blood can cause profuse and persistent bleeding whenever you there is an injury. If your platelet count is up to or above the normal range, you are less likely to get bleeding symptoms. Under such circumstances, it is safe to undergo most surgeries and also to have a normal vaginal delivery.
In people with ITP, the immune system treats platelets as foreign and destroys them. The spleen, which acts as a blood filter, is responsible for removing these damaged platelets. Therefore removal of the spleen can help to keep more platelets circulating in the body. Splenectomy used to be the standard treatment for ITP before drug therapies were developed. It is still carried out in patients with chronic severe ITP (troublesome ITP for a year or more). Surgeons often perform splenectomy using a laparoscopic procedure also known as a keyhole surgery. This procedure has the advantage of a shorter hospital stay and quicker recovery time. However, in some patients the surgeon may need to revert to open surgery. This usually is the case if the spleen is particularly large or if there are any other complications.
Many women with low platelets are concerned about having a family. A low platelet count does not prevent a woman from conceiving pregnancy or delivering a healthy offspring. However, the situation calls for special attention and close coordination between the woman’s haematologist, obstetrician, and paediatrician. If you were diagnosed with ITP before you became pregnant, you may find that your pregnancy will either make the ITP better or worse. Most women, who are suffering from ITP before pregnancy, do not require any treatment for ITP during their pregnancy.
Treatment for pregnant women with ITP depends on the platelet count. In case of mild ITP, you probably won’t need any treatment other than careful monitoring and regular blood tests.
With extremely low platelet or excessive bleeding, you’re more likely to experience serious, heavy bleeding during and after delivery. In these cases, we will work with you to determine a treatment plan that will help maintain a safe platelet count without adversely affecting your baby. In pregnancy, treatment for immune thrombocytopenic purpura (ITP) and neonatal alloimmune thrombocytopenia (NAIT) involves two patients: mother and her baby. Care of an affected mother centers on minimizing her risk of bleeding during pregnancy and childbirth. Doctors prefer to do regular checks on platelet counts throughout pregnancy to ensure that they are in an acceptable range. At present, no truly reliable method exists for determining which newborns are at risk for severe thrombocytopenia.
In cases of ITP, precautionary measures for the mother involves minimizing her risk of bleeding during pregnancy and childbirth and regular checking of platelet counts throughout gestation to verify that they are in an acceptable range. As a usual practice while treating ITP patients, doctors prefer to check platelet counts on a monthly basis during pregnancy. Even in completely stable patients, the Doctor checks for platelet count, at least every trimester.
How does it affect the baby?
When the fetus or baby is concerned, the major neonatal concern in ITP is the risk of fetal or newborn intracranial or visceral haemorrhage due to severe thrombocytopenia. Newborn thrombocytopenia is difficult to predict because newborn platelet counts do not always correlate with maternal platelet counts. Maternal platelet counts that fall within the reference range after previous splenectomy or corticosteroid treatment do not guarantee a fetal platelet count within the reference range.
Although most babies born to mothers with ITP don’t inherit this disorder, rarely some are born with or develop a low platelet count soon after birth. In most cases, the platelet count will return to normal without any treatment. Treatment may be necessary for babies with very low platelet counts.
However, a history of ITP in a mother or ITP in a previous pregnancy is not a contraindication to future pregnancies.