Future mothers have to pass blood tests quite regularly. By their results, one can judge not only whether the woman has a normal hemoglobin level, or whether she has anemia. Also, the results of the study show whether everything is in order with platelets. Many women are familiar with the issue of low platelet count during pregnancy. Why does this happen? Can low platelet count during pregnancy pose a threat? What can be done to improve the situation?
Thrombocytes Norms during Pregnancy
Thrombocytes/platelets are blood cells that are responsible for blood coagulation and fluidity. These cells prevent the formation of thrombi.
Platelets are produced in the bone marrow and live no more than 10 days. For an adult, their number should be in the range from 150 to 400 K/mcL.
For pregnant women indicators are different: the norm of platelets during pregnancy should not go below the level of 140 thousand/mcl. Otherwise thrombocytopenia develops.
Statistics show that most women have low platelet count during pregnancy, compared with the data taken before pregnancy. This is because the volume of circulating blood increases, as does its flow.
Therefore, the level of platelets during pregnancy, that doesn’t go beyond the lower limit, is considered the norm.
Platelets: Functions and Abnormalities
These cells are responsible for blood coagulability. When we accidentally hurt, then the injured skin immediately begins to bleed. And the platelets (the components of the blood) create a thrombus on the outer surface of the wound. As a result, it clogs the wound. Thus, the nature has ensured that in cases of injuries of this kind, the body will save itself.
Normally, the platelet count in women is 180-320 thousand K/mcL. But everyone knows that pregnancy changes a lot in the body of a woman. It reduces immunity, rebuilds the hormonal background, etc. Some processes of vital activity slow down, while others accelerate.
The exact and unique reason for the low platelet count during pregnancy is not established. There are only assumptions. According to one version, old platelets during pregnancy are destroyed. The new ones are synthesized slowly and do not cope with their functions. The second explanation is based on the fact that blood plasma is produced in excess – and such components become smaller. Lupus is another cause of blood pathology.
Thrombocytopenia is a persistent decrease in platelet count in the blood. If a pregnant woman is diagnosed with such a problem, urine testing should be done. It will show and confirm the dynamics of low platelet count during pregnancy. Platelets deficiency can be manifested by diapedetic rash, that is, small bleeding. They can be nasal, gastrointestinal, hemorrhoidal. Bleeding from the uterine cavity is also possible.
Keep in mind that thrombocytopenia during pregnancy is dangerous because of high probability of hemorrhages. They occur in the intracranial cavity and organs. There is also a risk of thrombocytopenia in a future child. That is why the future mothers must be responsible with passing blood tests.
Causes of Low Platelet Count during Pregnancy
Low platelet count during pregnancy can be caused by various reasons, among which are:
- Pathology in the functioning of a coagulation system.
- Viral infections.
- Lupus erythematosus.
- The presence of bleeding.
- Late toxicosis, taking place in a severe form.
- Taking certain medications (diuretic, some antibacterial).
- Inadequate amount of folic acid in the body.
- Allergic manifestations.
- Poor nutrition.
- Disorders in the work of the immune and endocrine systems.
Low platelet count during pregnancy leads to the fact that the woman has bruises that do not last a long time, and bleeding, which is difficult to stop.
During this period, the pregnant woman should pay special attention to her health, regularly undergo examinations with the observing gynecologist and take tests.
Symptoms of Low Platelet Count during Pregnancy
- bleeding of the gums (not associated with pregnancy gingivitis);
- the appearance of bruising without cause or after a micro-injury (when minor damage causes extensive bruising);
- frequent nasal bleeding;
- bleeding from the gastrointestinal tract (including hemorrhoids);
- the appearance of a small-point specific rash on the skin (more often the rash is present on the limbs and the front surface of the body);
- increase of the duration of bleeding from small cuts or after tooth extraction.
In order to confirm the diagnosis, one needs to:
- pass a general blood test;
- make a study of blood coagulability (coagulogram);
- undergo additional studies in order to exclude diseases that may be the cause of thrombocytopenia;
- visit a hematologist.
Low platelet count during pregnancy is dangerous not only because of the risk of bleeding during labor, but also because it can cause bleeding of internal organs, and even brain hemorrhage.
In addition, with autoimmune thrombocytopenia, maternal antibodies can get through the placental bloodstream to the fetus. In this case, there is a high probability of developing thrombocytopenia in the newborn.
What’s the Danger of Low Platelet Count during Pregnancy?
The norm of platelets during pregnancy should not exceed deviations of more than 10-20% in relation to the accepted values of the norm for an adult.
If platelets are reduced during pregnancy, and the prescribed treatment did not give the expected result, there may be complications in the process of delivery.
- Firstly, delivery by decision of a doctor’s consultation in such a state is likely to be through a cesarean section.
- Secondly, even this method of delivery is dangerous because there may be difficulties with stopping bleeding.
- Thirdly, a child born with thrombocytopenia may have internal bleeding.
Therefore, it is very important to increase platelets during pregnancy.
Another feature characteristic of those who have low platelet count during pregnancy is a contraindication in the use of epidural or spinal anesthesia.
Diagnosis of Thrombocytopenia in Pregnant Women
You can determine the number of platelets in pregnancy by a general blood test.
If there are any abnormalities, doctors suggest conducting additional studies to establish an accurate diagnosis:
- Other tests to exclude diseases that cause secondary thrombocytopenia.
The observing gynecologist issues a referral to the hematologist who selects the treatment based on the protocol of analysis and the individual characteristics of the pregnant woman.
Basically, this is usually the taking of certain medications.
Low Platelet Count during Pregnancy: Treatment
Treatment of thrombocytopenia should begin with the elimination of the cause. If there are pronounced subcutaneous hemorrhages or bleeding from the mucous membranes, thrombocytopenia is treated as an independent disease. With a sharp decrease in platelet count, hospital treatment is necessary.
How to Increase Platelets in Pregnant Women?
Corticosteroids (Prednisolone, Dexamethasone). They contribute to the rapid increase (in 5-7 days) of the platelet count in the blood of the pregnant woman. Also, they reduce the risk of bleeding. In addition, glucocorticoids contribute to the accelerated process of maturing of the baby’s lungs. Therefore, in the presence of medical evidence, an early delivery of a woman with thrombocytopenia is possible. Doctors assign these drugs for 5-10 days, followed by a gradual cancellation (3-4 days). If there is a relapse of thrombocytopenia, the course can be repeated.
With insufficient effectiveness of glucocorticoids or when it is impossible to use them, intravenous immunoglobulin injections are prescribed. This is a much more expensive treatment. However, immunoglobulin increases platelet levels more quickly. During the entire pregnancy period, 3-4 injections can be given. Also, the drug is administered during labor and immediately afterwards.
Very rarely, a transfusion of donor platelet mass is performed.
When bleeding from the mucous membranes of the mouth occurs, rinsing with aminocaproic acid is prescribed.
If none of the treatment method brings an effective result, then splenectomy (removal of the spleen) is performed in the 2nd trimester. Doctors decide on this extreme measure because the spleen is the organ in which platelets are destroyed. To avoid the risk of damage to the fetus, laparoscopic access to the spleen is used. Most often, such an operation is indicated for autoimmune thrombocytopenia.
The question of the delivery of a woman with a poorly controlled low platelet count during pregnancy is decided by a doctor’s consultation. The decision depends on the individual course of this pathological condition.