Platelets And Parturition - A Case Series on Thrombocytopenia in Pregnancy

Abstract

Background: Thrombocytopenia is a frequent hematological abnormality in pregnancy, affecting 7–10% of women. While gestational thrombocytopenia is usually benign, pathological causes such as immune thrombocytopenic purpura (ITP), inherited platelet function disorders, and thrombocytopenia associated with autoimmune disease carry significant maternal and perinatal risks. Objective: To present and analyze four cases of thrombocytopenic disorders in pregnancy, highlighting the spectrum of etiologies, management challenges, and maternal–neonatal outcomes. Case Presentation: This series describes four pregnant women with distinct thrombocytopenic disorders: Bernard–Soulier syndrome, chronic ITP, refractory ITP post-splenectomy, and ITP associated with autoimmune disease (APLA positivity). Clinical presentations included severe thrombocytopenia, bleeding diathesis, superimposed preeclampsia with placental abruption, and preterm premature rupture of membranes. Management strategies were individualized, incorporating corticosteroids, intravenous immunoglobulin, immunosuppressants, and platelet transfusions, with multidisciplinary input from hematology, obstetrics, anesthesiology, and rheumatology. Obstetric outcomes varied, with both cesarean and vaginal deliveries undertaken based on clinical indications. Maternal complications included postpartum hemorrhage, abruptio placentae, and fluctuating platelet counts postpartum. Neonatal outcomes ranged from neonatal immune thrombocytopenia requiring IVIg to extreme prematurity. Conclusion: Thrombocytopenia in pregnancy requires accurate etiological diagnosis and a multidisciplinary, guideline-directed approach. Corticosteroids and IVIg remain cornerstone therapies in ITP, while platelet transfusion is vital in inherited platelet disorders. Delivery planning should be obstetric-driven with optimization of platelet counts. Neonatal monitoring is essential, particularly for infants of ITP mothers, to detect and manage neonatal thrombocytopenia. Early diagnosis, proactive peripartum care, and coordinated follow-up optimize maternal and neonatal outcomes even in complex, high-risk cases.