Thrombocytopenia In Pregnancy

A 28-year-old G2P1 at 32 weeks of gestation presents with a platelet count of 125 × 10^9/L. She denies bleeding symptoms. Her blood pressure is 110/70 mm Hg. She has no proteinuria, normal liver function tests, and no prior history of thrombocytopenia outside of pregnancy. Fetal growth is appropriate for gestational age.

Question: What is the most likely diagnosis?

A 39-year-old G3P2 is found to have a platelet count of 60 × 10^9/L at 20 weeks of gestation. In her previous pregnancies, platelet counts were mildly low only at term but normalized postpartum. She currently has no bleeding or bruising.

Question: Which of the following findings in this clinical scenario strongly points away from gestational thrombocytopenia?

Which of the following statements regarding gestational thrombocytopenia is true?

In differentiating ITP from gestational thrombocytopenia (GT), which historical or clinical feature would most strongly suggest ITP?

A 35-year-old G1P0 at 36 weeks of gestation has BP readings of 160/90 mm Hg and a platelet count of 95 × 10^9/L. She also has persistent right upper quadrant pain and mildly elevated liver enzymes.

Question: What is the most appropriate next step in management?

A 29-year-old G2P1 at 33 weeks is admitted with severe preeclampsia. Platelet count is 45 × 10^9/L. An urgent cesarean is planned due to a nonreassuring fetal heart tracing.

Question: How should her thrombocytopenia be managed before surgery?

In preeclampsia/HELLP syndrome, at what platelet threshold is platelet transfusion generally recommended before a cesarean delivery?

Which of the following is not typically associated with HELLP syndrome?

Which statement is true regarding management of preeclampsia with severe features and thrombocytopenia?

A 30-year-old woman at 28 weeks of gestation has a platelet count of 65 × 10^9/L on routine labs. She has a history of ITP diagnosed 3 years ago. She reports mild gum bleeding occasionally. Blood pressure is normal; LFTs are normal.

Question: What is the best initial management to increase her platelet count?

A 32-year-old G2P1 at 38 weeks has a platelet count of 30 × 10^9/L and a known history of ITP. She desires a vaginal delivery and is requesting an epidural for labor analgesia. No significant bleeding is noted except mild bruising.

Question: What is the most appropriate plan for delivery?

For patients with ITP in pregnancy, which initial therapy is generally recommended for mild bleeding or platelet counts below 70 × 10^9/L?

Which statement regarding neonatal management in a mother with ITP is correct?

A 26-year-old G2P1 with a prior pregnancy complicated by severe fetal–neonatal alloimmune thrombocytopenia (FNAIT) is now 24 weeks pregnant. The fetus is confirmed positive for HPA-1a, and maternal anti-platelet antibodies are present.

Question: What intervention is most commonly recommended to prevent fetal intracranial hemorrhage?

A 35-year-old with a history of FNAIT leading to neonatal intracranial hemorrhage at 36 weeks in her prior pregnancy. Current fetus is HPA-1a positive. She has been on weekly IVIG since 20 weeks. Cordocentesis at 32 weeks reveals fetal platelets at 45 × 10^9/L.

Question: What is the most appropriate delivery plan?

Which condition is most commonly associated with severe fetal thrombocytopenia and in utero intracranial hemorrhage?

Which of the following statements about fetal–neonatal alloimmune thrombocytopenia (FNAIT) is true?

A 31-year-old G1P0 at 34 weeks with ITP has a platelet count of 80 × 10^9/L. She strongly desires an epidural for labor analgesia.

Question: What is the recommended minimum platelet count for safe epidural anesthesia, assuming stable platelet levels and no coagulopathy?

A 29-year-old G2P1 at 38 weeks has severe preeclampsia. Platelet count is 40 × 10^9/L. She wants an epidural for induction of labor.

Question: What is the best recommendation regarding epidural anesthesia in this scenario?

Which statement best describes the safe approach to regional anesthesia when platelet counts are borderline low (65–75 × 10^9/L) and stable?