Management Of Birth When Mother Has Low Platelets

[lisab]

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?

 

[Evo]

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.

 

[lisab]

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.

 

[bobze]

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.

 

[lisab]

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.