From the Guidelines
Cesarean section (CS) is not indicated for pregnant women with Immune Thrombocytopenia (ITP) unless there are obstetric indications. The mode of delivery in ITP patients should be determined by purely obstetric indications, as there is no evidence that cesarean section is safer for the fetus with thrombocytopenia than uncomplicated vaginal delivery 1.
Key points to consider:
- The risk of intracranial hemorrhage (ICH) in infants with neonatal thrombocytopenia is low, ranging from 0% to 1.5% 1.
- Most hemorrhagic events in neonates occur 24 to 48 hours after delivery, at the nadir of the platelet count 1.
- There is no evidence to support the routine use of intrapartum fetal platelet counts or specific platelet count thresholds that are “safe” in the ante- or peripartum period 1.
- Delivery of neonates in women with ITP should be based on obstetric indications, and cesarean section should only be considered if there are obstetric indications 1.
In terms of management, the focus should be on assessing maternal bleeding risks associated with delivery, epidural anesthesia, and the minimum platelet counts required to safely undergo these procedures 1. However, the decision to perform a cesarean section should be based on obstetric indications, rather than the presence of ITP alone.
From the Research
PG with ITP indicated for CS
- The use of cesarean section (CS) for pregnant women with idiopathic thrombocytopenic purpura (ITP) is a topic of discussion among medical professionals 2, 3.
- Some studies suggest that CS should be the preferred route of delivery for mothers with ITP, as affected infants may be severely thrombocytopenic at birth and at risk for hemorrhagic symptoms secondary to the stress of vaginal delivery 2, 3.
- However, other studies argue that CS should only be performed for obstetric indications, as the outcome of pregnancy in pregnant women with ITP is generally good and postpartum hemorrhage is common in these women regardless of the mode of delivery 4.
- Fetal thrombocytopenia is a concern in pregnancies with ITP, and some studies suggest that fetuses with platelet counts of less than 50 x 10^9/L should be delivered by CS, while those with counts greater than 50 x 10^9/L can proceed with vaginal delivery assuming no obstetrical contraindications exist 5.
- The management of ITP in pregnancy is complicated, and maternal treatment or response to treatment is inconsistently associated with predictable changes in the fetal platelet count 5.
- Understanding the pathophysiology, treatments, and risks to the mother and fetus leads to proper management resulting in successful pregnancy and delivery in almost all cases 6.