Management Of Birth When Mother Has Low Platelets

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In summary, a good friend's wife who is 38 weeks pregnant has been experiencing a decrease in her platelet count, which raises concerns about the possibility of a Cesarean section. This is due to the potential for uncontrolled bleeding during a vaginal birth, and the ability to better control and stop bleeding during a surgical birth. The conversation also highlights the potential risks of birth before modern medicine, and the advantages of a controlled medical setting.
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lisab
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A good friend of mine's wife is at 38 weeks in her first pregnancy. Her platelet count has been decreasing steadily in the last few weeks. Her midwife said it's not critical but it is now at a level that is a concern, and it raises the chance of Cesarean section.

Why would a Cesarean be a better choice in this situation? It seems if a patient has low platelets you'd want to minimize trauma to reduce the chance of bleeding. I know there can be significant trauma during birth, but abdominal surgery is pretty darn traumatic, too.

Is it because the trauma of a vaginal birth is somewhat uncontrolled?

Or is it to better control the separation of the placenta from the uterus?
 
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Considering how normal my pregnancy was and then the unexpected complications during labor and the amount of hemorrhaging and blood loss I had during labor, it is a real concern. They kept trying to put those large absorbent surgical pads under me but the blood was just flowing off of them and running off the bed and pooling onto the floor. It was quite bad. They had stacks of towels. It looked liked a massacre. And this was still during the mid stages of labor. My husband was so upset he put his fist through the wall. I don't think they knew what they were doing. It was my first pregnancy, I didn't know what was normal, it was a private delivery room, so there was no one else in there to say something was terribly wrong. My doctor was on vacation and her back up was no where to be found. We just kept hearing the nurses whispering "blood", "can't find her doctor". But they kept telling us everything was ok, except it turned out nothing was ok. Good thing I was in a hospital or I probably would have lost my daughter.
 
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Did you have dropping platelets as you approached full term?

I've know several women who have had experiences like yours. No surprise surviving birth was quite uncertain before modern medicine. Good health and fitness guaranteed nothing.
 
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lisab said:
Is it because the trauma of a vaginal birth is somewhat uncontrolled?

This.

We can and do often take people to the OR with thrombocytopenia. Because in a controlled setting when you are dissecting tissue planes, it is easy to clamp, apply pressure, bovie (electrocautery) or suture your way to hemostasis.

In traumatic bleeding you have an uncontrolled situation where it is hard to get hemostasis and often requires opening someone up to find out what is bleeding anyway. So better to just have the surgical intervention in the first place.
 
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bobze said:
This.

We can and do often take people to the OR with thrombocytopenia. Because in a controlled setting when you are dissecting tissue planes, it is easy to clamp, apply pressure, bovie (electrocautery) or suture your way to hemostasis.

In traumatic bleeding you have an uncontrolled situation where it is hard to get hemostasis and often requires opening someone up to find out what is bleeding anyway. So better to just have the surgical intervention in the first place.

Thanks - that makes sense.
 

1. What are platelets and why are they important during birth?

Platelets are small, colorless blood cells that help with blood clotting. They are important during birth because they prevent excessive bleeding, which is especially critical during the delivery of a baby.

2. How do low platelet levels affect the management of birth?

Low platelet levels, also known as thrombocytopenia, can increase the risk of excessive bleeding during birth. This may lead to complications for both the mother and the baby. Therefore, it is important to closely monitor platelet levels and manage them accordingly during birth.

3. What are the risks associated with low platelets during birth?

The main risk associated with low platelets during birth is excessive bleeding, also known as hemorrhage. This can lead to serious consequences for both the mother and the baby, including shock, organ damage, and even death. Additionally, low platelet levels may also increase the risk of needing a blood transfusion.

4. How is the management of birth different for mothers with low platelets?

The management of birth for mothers with low platelets may involve close monitoring of platelet levels, administration of medications to increase platelet counts, and careful consideration of the mode of delivery. In some cases, a cesarean section may be recommended to minimize the risk of excessive bleeding.

5. Can low platelets be prevented during pregnancy?

In some cases, low platelets during pregnancy may be caused by a medical condition, such as autoimmune disorders or certain infections. In these cases, it may not be possible to prevent low platelet levels. However, maintaining a healthy diet and avoiding activities that may increase the risk of bleeding, such as contact sports, can help prevent low platelets during pregnancy.

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