Abstract Number: PB1311
Meeting: ISTH 2021 Congress
Background: ITP which is the most common cause of thrombocytopenia in early pregnancy can be challenging due to limited treatment options in pregnancy and at times an unexpected fall in the platelet count on arrival in labour.
Aims: We reviewed the adherence to the intrapartum care plans provided by the Obstetric Haematology team using the 2019 International Consensus Guidelines as standard.
Methods: 20 patients selected at random with diagnosis of ITP in pregnancy. Characteristics were:median age 31(age 21 to 43),10 prima gravid patients, 9 patients with history of ITP while 11 patients had newly diagnosed ITP in pregnancy.
Results: 4 patients in their third trimester with platelet count between 40 to 60 were started on Prednisolone 20mg daily with good response.1 patient dropped platelet count to 7 in second trimester. She responded well to 20mg prednisolone and had uneventful delivery. 8 patients with platelet count above 70 had neuraxial anaesthesia without complications. 1 patient had splenectomy prior to pregnancy and did not have a relapse during pregnancy.13 patients had spontaneous vaginal delivery and 4 had caesarean section for obstetric reasons. None of the patients required emergency treatment at delivery.5 of 20 babies were born with neonatal thrombocytopenia. One baby with a sibling affected with neonatal thrombocytopenia had platelet count of 89 at birth which further dropped to 39 a week later and recovered spontaneously 3 days later.None of the women reported any significant bleeding in the post partum period. There were no deviations from the recommendations specified in the intrapartum care plan in any of the cases.
Conclusions: In conclusion, we note that our patients responded well to prednisolone 20mg without complications. Neonatal thrombocytopenia was higher than expected at 25% , however was managed as advised with no issues.Our study reassured us of the value of the documented intrapartum care plan and how advice was reliably followed.
To cite this abstract in AMA style:Dhanapal J, Pavord S. Review of Intrapartum Management of ITP in Pregnancy in John Radcliffe Hospital [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/review-of-intrapartum-management-of-itp-in-pregnancy-in-john-radcliffe-hospital/. Accessed September 24, 2021.
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