Does a pregnant woman at 29 weeks gestation with thrombocytopenia (platelet count of 69,000) require corticosteroids, such as betamethasone (betamethasone), for fetal lung maturity, despite no current plans for delivery?

From the Guidelines

Corticosteroids for fetal lung maturity are not indicated for a pregnant woman at 29 weeks gestation with thrombocytopenia (platelet count of 69,000) if there are no plans for delivery. Antenatal corticosteroids like betamethasone are specifically administered when preterm delivery is anticipated within 7 days, not as a treatment for maternal thrombocytopenia 1. The thrombocytopenia itself requires evaluation to determine its cause (such as gestational thrombocytopenia, immune thrombocytopenia, or preeclampsia), but does not automatically warrant corticosteroid administration for fetal lung development.

Some key points to consider in the management of this patient include:

• The use of antenatal corticosteroids in the late preterm period has been shown to reduce neonatal morbidity, but the long-term risks remain uncertain 1.
• The Society for Maternal-Fetal Medicine recommends against the use of antenatal corticosteroids for fetal lung maturity in pregnant patients with a low likelihood of delivery before 37 weeks of gestation (GRADE 1B) 1.
• If the clinical situation changes and delivery becomes necessary before 34 weeks gestation, then a course of betamethasone (12 mg intramuscularly, repeated once 24 hours later) would be recommended to accelerate fetal lung maturity and reduce neonatal complications.
• The maternal thrombocytopenia should be monitored and managed separately according to its etiology, with platelet transfusion typically considered only if the count falls below 50,000/μL or if delivery is imminent 1.

It is essential to note that the primary goal of antenatal corticosteroid administration is to reduce neonatal morbidity in pregnancies at risk for preterm delivery before 37 weeks of gestation 1. Therefore, the decision to administer corticosteroids should be based on the individual patient's risk of preterm delivery and the potential benefits and risks of treatment.

From the Research

Thrombocytopenia and Corticosteroids in Pregnancy

• A pregnant woman at 29 weeks gestation with a platelet count of 69,000, which has decreased from an initial count of 350,000, may be considered for corticosteroid treatment to promote fetal lung maturity, despite no current plans for delivery.
• According to a study published in 2006 2, betamethasone administration can increase platelet count in both thrombocytopenic and normal pregnant women, suggesting a potential role for corticosteroids in the treatment of thrombocytopenia in pregnancy.
• However, the primary goal of corticosteroid treatment in this context is to promote fetal lung maturity, as evidenced by a study published in 2017 3, which compared the effectiveness of different antenatal corticosteroid regimens in promoting fetal lung maturation.

Fetal Lung Maturity and Corticosteroids

• The use of corticosteroids, such as betamethasone, to promote fetal lung maturity is a well-established practice in obstetrics, as discussed in a review published in 2009 4.
• However, the benefits and risks of corticosteroid treatment must be carefully considered, particularly in cases where delivery is not imminent, as noted in a study published in 2012 5, which found that antenatal corticosteroids given after 34 weeks of gestation did not reduce respiratory morbidity in neonates.

Platelet Transfusions and Thrombocytopenia

• In cases of severe thrombocytopenia, platelet transfusions may be considered, as discussed in a review published in 2011 6, which highlighted the lack of evidence-based guidelines for platelet transfusions in neonates.
• However, the decision to administer corticosteroids or platelet transfusions should be made on a case-by-case basis, taking into account the individual patient's circumstances and the potential risks and benefits of treatment, as supported by studies 2, 6.