Thrombocytopenia in pregnancy
- James N George, MD
James N George, MD
- Professor of Medicine
- University of Oklahoma Health Sciences Center
- Jennifer J McIntosh, DO, MS
Jennifer J McIntosh, DO, MS
- Assistant Professor of Maternal Fetal Medicine
- Medical College of Wisconsin
- Section Editors
- Lawrence LK Leung, MD
Lawrence LK Leung, MD
- Editor-in-Chief — Hematology
- Section Editor — Disorders of Hemostasis and Coagulation
- Professor of Medicine
- Stanford University School of Medicine
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Deputy Editors
- Jennifer S Tirnauer, MD
Jennifer S Tirnauer, MD
- Deputy Editor — Hematology
- Vanessa A Barss, MD, FACOG
Vanessa A Barss, MD, FACOG
- Senior Deputy Editor — UpToDate
- Deputy Editor — Obstetrics, Gynecology and Women's Health
- Associate Clinical Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
Evaluation and management of thrombocytopenia during pregnancy and postpartum may be challenging because there are many potential causes, some directly related to the pregnancy and some unrelated. For many of the causes there are no diagnostic laboratory tests. Management options may have the potential for serious complications for both mother and fetus and may require urgent decisions about delivery, and there may be concerns about fetal thrombocytopenia.
This topic reviews our approaches to determining the cause of thrombocytopenia in a pregnant woman and to management during pregnancy and delivery, which in some cases cannot wait for full diagnostic evaluation.
Additional information on the diagnosis and management of specific conditions that cause thrombocytopenia is presented in more detail separately:
●Immune thrombocytopenia (ITP) – (See "Immune thrombocytopenia (ITP) in adults: Clinical manifestations and diagnosis".)
●Drug-induced thrombocytopenia – (See "Drug-induced immune thrombocytopenia".)
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- DEFINITION AND INCIDENCE
- LIST OF CAUSES
- Gestational thrombocytopenia (GT)
- Preeclampsia with severe features/HELLP
- Acute fatty liver of pregnancy
- Thrombotic microangiopathy (TMA)
- - TTP
- - Complement-mediated TMA
- - ST-HUS
- Causes of thrombocytopenia not triggered by the pregnancy
- DETERMINING THE LIKELY CAUSE(S)
- Overview of the evaluation
- Isolated, asymptomatic thrombocytopenia; platelets >80,000
- Acutely ill, platelets <80,000, bleeding, thrombosis, or other major findings
- MANAGEMENT DECISIONS
- Treatment of bleeding or severe thrombocytopenia
- Frequency of platelet count monitoring
- Need for urgent/emergent delivery
- - Conditions treated by delivery
- - Conditions not treated by delivery
- Need for plasma exchange or anti-complement therapy
- Need for other medications
- - ITP therapies
- - Anticoagulation for HIT
- - Antibiotics
- Neuraxial anesthesia
- Neonatal testing
- Recurrence in future pregnancies
- SUMMARY AND RECOMMENDATIONS