Thrombocytopenia in pregnancy

Thrombocytopenia during pregnancy is quite common.

Thrombocytopenia is a disease in which the percentage of platelets in the blood decreases. Platelets are a type of megakaryocytic cytoplasm that does not contain a nucleus. Also, platelets take part in localized inflammatory processes. In the shell of platelets contain special molecules that recognize damage in the vessels. Thus, the platelet is inserted into the wall of the damaged vessel and acts as a live patch. However, the main role of platelets after all is to stop bleeding. Platelets are formed from platelets, factors that narrow the vascular walls are formed, and a system that influences the formation of a fibrin clot is activated. Platelets are produced by cells of the red bone marrow, with unfavorable factors the process of production is inhibited and thrombocytopenia arises - low coagulability of the blood. Visually, the lack of platelets is manifested in the form of diapedesis rash - small bleeding. Thrombocytopenia in pregnancy is dangerous because the probability of hemorrhages in the organs and intracranial cavity is very high. There is also a risk of developing thrombocytopenia in the fetus. Therefore, pregnant women should take special care to take blood tests and assess the possible risk in the absence of treatment.

Causes of thrombocytopenia in pregnancy

The causes of thrombocytopenia in pregnancy are different, this is not uncommon pathology. The main causes of thrombocytopenia:

• reduction in the viability of platelets due to hormonal imbalance;
• increase in blood volume and, because of this, a decrease in the percentage of platelets;
• malnutrition associated with inadequate intake of essential vitamins, namely follates, vitamin 12;
• the state of neuropathy in pregnant women, preeclampsia, eclampsia;
• infectious diseases of a viral nature;
• the development of autoimmune thrombocytopenia with the activation of the immune system in pregnant women;
• presence of allergy;
• obstetric hemorrhage (with placental abruption);
• with intrauterine fetal death;
• various intoxications and side effects after taking antibacterial drugs.

It is also possible to physiological decrease in the percentage of platelets in the blood (100 * 109). It does not require specific treatment, only control of blood tests is shown. If the fact of abnormal decrease of platelets is fixed, then urgent elimination of the cause and special individual treatment are required. These measures are necessary to prevent dangerous pathologies during pregnancy and childbirth.

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Symptoms of thrombocytopenia in pregnancy

Symptoms of thrombocytopenia in pregnancy have a more vivid and diverse description than in other patients. Pregnant women are characterized by:

• Appearance on the skin of small hematomas after touch, sometimes even without external influence on them.
• Various bleeding - nasal, from the gums. But this sign can not be called purely specific, many pregnant women against the background of vitamin deficiency develop gum disease.
• Bleeding from the gastrointestinal tract, hemorrhages from the cracks of the anus, hemorrhoids in hemorrhoids, are also fixed.
• Bleeding from the uterine cavity, not associated with the menstrual cycle.
• Appearance of small-point hemorrhages affecting the anterior surface of the trunk and limb.

Symptoms of thrombocytopenia during pregnancy indicate very serious violations of the process of hematopoiesis. This is very dangerous as in the period of pregnancy, and in childbirth. Particular danger is the high probability of bleeding, which can cost the life of the most pregnant, and lead to the development of thrombocytopenia in a newborn. In childbirth, women with thrombocytopenia are forbidden to carry out any actions, accompanied by physical effects on the child, as this can cause bleeding in the intracranial cavity.

Secondary thrombocytopenia in pregnancy

Secondary thrombocytopenia during pregnancy is most often diagnosed in the second trimester of pregnancy and can develop in several cases. Basically, this kind of thrombocytopenia develops due to body irradiation (radiation sickness), poisoning with toxic compounds (heavy metal salts, gasoline derivatives, alcohol), and thrombocytopenia can form as a symptom in a disease such as uremia. In addition, secondary thrombocytopenia during pregnancy develops with toxic damage to the bone marrow and suppression of the growth of megakaryocytes, when bacterial poisons are affected by the brains, and especially the harmful effects of viruses (chicken pox, scarlet fever, measles, infectious mononucleosis, etc.). Preparations of the group of cytostatics also reduce the level of platelets, since they are directed at suppressing the growth of megakaryocytes. Also, thrombocytopenia develops in leukemia, when the bone marrow is reborn and replaced by the stroma, and splenomegaly - excessive hypertrophy of the spleen due to liver dysfunction or if the splenic vein is impassable.

Secondary thrombocytopenia during pregnancy is especially dangerous for a child, since antibodies with blood flow easily penetrate the umbilical cord into his body and this leads to the destruction of platelets in the fetus. But with timely diagnosis and special treatment, the prognosis for the mother and child is favorable.

Diagnosis of thrombocytopenia in pregnancy

Diagnosis of thrombocytopenia during pregnancy primarily involves laboratory diagnostic methods. So, the diagnosis of thrombocytopenia consists of several stages:

• Medical examination.
• Conducting a blood test (biochemical and clinical).
• Detection of clotting factor.
• A blood test, indicating whether the autoantibodies are produced to platelets.
• Carrying out an aspiration biopsy of the bone marrow.

The blood test is the most convenient way to estimate the percentage of blood in the leukocytes, red blood cells and platelets. Urine is also analyzed for hemosiderin.

If during a physical examination of a pregnant woman the symptoms of thrombocytopenia appear visually - a small-dot rash on the skin, small hemorrhages in the oral mucosa, conjunctiva, then this is an occasion to conduct not only a blood test, but also a bone marrow puncture. With the prevalence of a large number of megakaryocytes in the smear of the bone marrow, the platelets in the body are destroyed or deposited in the spleen.

Confirmation of thrombocytopenia requires a doctor-hematologist to conclude on the nature of the disease and pathogenesis. In the future, as soon as possible, specific treatment is prescribed, which gives a favorable prognosis for both the mother and the child.

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Treatment of thrombocytopenia in pregnancy

Treatment of thrombocytopenia during pregnancy begins as soon as possible after confirmation of the alleged analysis. Thrombocytopenia develops usually in the third trimester of pregnancy, and at this time the probability of intrauterine destruction of platelets in the fetus is high, due to the transfer of antibodies to the mother through the umbilical cord into the fetal blood flow.

Urgent treatment requires thrombocytopenia with a percentage of platelets less than 20-40 * 109 per liter. It is also important not only to influence the cause of platelet deficiency, but also to normalize the hemostasis. In such cases, the basis of therapeutic measures is the appointment of glucocorticosteroids (prednisolone, dexamethasone, etc.). They are prescribed systemically, in a short course, and the dosage is gradually reduced until there is a pronounced positive result.

If the administration of glucocorticosteroid does not produce the desired result, immunoglobulins are injected intravenously. Assign them one-time, but according to the following system: 3-4 times during pregnancy, during childbirth and after childbirth. In especially rare and complex cases, an intravenous thrombocyte mass is prescribed.

If all available conservative methods of treatment do not work, during the second trimester of a pregnant woman, an operation is performed to remove the spleen, and to exclude all the risks of a lumbar operation, the removal is performed laporascopically. The prognosis of conservative treatment and the postoperative period for the baby and fetus is positive.

Preventing thrombocytopenia in pregnancy

Prevention of thrombocytopenia during pregnancy is reduced to the exclusion of factors provoking the dysfunction of the immune system of a woman. This is isolation from patients or vaccination before pregnancy from measles, rubella, chicken pox, influenza and ARVI; fencing from communication with patients and carriers of cytomegalovirus infection, other childhood infections. Viruses for pregnant women are especially dangerous, since they release toxins that depress the bone marrow, resulting in a decrease in platelet production and thrombocytopenia.

Also, when confirming pregnancy, you must refuse to vaccinate and take certain medications, namely:

• antineoplastic;
• estrogens;
• thiazide diuretics;
• alcohol-containing preparations;
• quinidine;
• heparin;
• sulfonamides;
• aspirin;
• other anticoagulants and antiaggregants.

Also it is necessary to be protected as much as possible from the effects of chemical toxins, irradiation.

It is necessary to eat all the necessary vitamins, nutritional supplements, which will have a positive effect on the state of the immune system and the health of the fetus. Also in the early stages of pregnancy, a consultation of the hematologist and genetics is shown, especially if cases of thrombocytopenia of a hereditary character are recorded in the family.

Prognosis of thrombocytopenia in pregnancy

The prognosis of thrombocytopenia during pregnancy is generally favorable. Thrombocytopenia in pregnant women occurs in 1-2 percent of cases in the last trimester. In more than half of cases, this pathology has a hormonal character, that is, it is associated with changes in the body, natural for pregnancy. Lack of platelets with values above 20-40 * 109 per liter does not require specific treatment. But such a pathology as immune thrombocytopenia is dangerous for the fetus. Antibodies, getting through the umbilical cord with the current of the mother's blood into the fetal blood flow, cause the death of platelets. When confirming thrombocytopenia, the fetus prohibits any obstetrical methods and operations in childbirth, as this is dangerous for the fetus and can provoke intracranial hemorrhage.

In general, labor with moderate thrombocytopenia is conservative. If the treatment of thrombocytopenia in a pregnant woman has not produced results or the condition has started to deteriorate sharply (hemorrhages have become more frequent, anemia is progressing), then the question of preterm delivery through caesarean section is raised. This will protect the fetus from trauma in childbirth and will give an opportunity to control blood loss in childbirth without harm to the mother and the fetus.

In acute form of thrombocytopenia, accompanied by massive bleeding, hemorrhages in the cranial cavity, pregnancy is not permissible. But with a pregnancy that has already begun, interruption is contraindicated, since it can endanger the life of a woman.