Management of Obstetric Patients with Thrombocytopenia

Patient Assessment and Referral

The American College of Obstetricians and Gynecologists recommends documenting any bleeding symptoms, including bruising, petechiae, and menorrhagia, in obstetric patients with thrombocytopenia 1
A comprehensive medical history, including hemostasis history, medication history, and family history of thrombocytopenia or bleeding disorders, should be recorded in obstetric patients with thrombocytopenia 1
The patient's current gestational age and details of the current pregnancy course should be documented 2

Complete blood count trends, focusing on platelet count values and trends over time, should be recorded in obstetric patients with thrombocytopenia 3, 4
Coagulation studies, including PT, INR, aPTT, and fibrinogen, should be performed in obstetric patients with thrombocytopenia 3
Tests to rule out secondary causes of thrombocytopenia, such as HIV, HCV, and H. pylori, should be considered in obstetric patients with thrombocytopenia 5

The mode of delivery should be determined by obstetric indications only, not maternal platelet count, in patients with thrombocytopenia 2, 5
Neuraxial anesthesia is generally considered safe in patients with platelet counts >75,000/μL 2
Potential treatments, such as corticosteroids and IVIG, may be needed in obstetric patients with thrombocytopenia 2, 5
A neonatal monitoring plan, including cord blood platelet count and transcranial ultrasound if platelets <50,000/μL, should be established in obstetric patients with thrombocytopenia 4, 6