“This means that, all things being equal, we will plan for a vaginal delivery with cesarean reserved for normal reasons,” she says, like your cervix not dilating enough within the usual time frame.
In the weeks leading up to delivery, your doctor will want to get your platelet count up to at least 50,000 per microliter of blood to reduce the risk of excessive bleeding, says Cindy Neunert, M.D., who specializes in pediatric hematology-oncology at Columbia University Irving Medical Center and chairs the guidelines panel for the 2019 American Society of Hematology Clinical Practice Guidelines on ITP. A platelet count above 80,000 per microliter of blood by the time of delivery is even better, Mohamad Cherry, M.D., medical director of hematology at Atlantic Health System Morristown Medical Center, tells SELF.
That higher-end goal of at least 80,000 platelets per microliter of blood is a big factor when it comes to your pain relief options during childbirth, particularly epidurals. Some research suggests that not having enough platelets may increase the risk of serious bleeding around the spine after an epidural. People with severely low platelet count may not be able to get an epidural, leaving them with fewer options for pain control, Dr. Zuckerwise says.
Remind your delivery team about your ITP so they can adjust their interventions accordingly. For example, they might want to forgo the use of forceps, which could otherwise lead to tearing and bleeding, says Dr. Zuckerwise.
It’s also worth noting that, although the Mayo Clinic points out that this is rare, your baby’s platelet count may be low after delivery too. After the delivery, your doctor should collect blood from the umbilical cord to check your baby’s platelet count, says Dr. Zuckerwise. Luckily, even if your baby does have low platelet count after childbirth, this will typically rectify itself on its own, the Mayo Clinic says. If not, treatments are available that may help.
Finally, as you’re looking into facts about chronic ITP in pregnancy, you’ll probably come across research that suggests you can pass anti-platelet antibodies to your baby through breast milk. “[This] may prolong the time that the infant has a low platelet count,” says Dr. Neunert. That doesn’t mean you have to go straight to formula if you would prefer to try to breastfeed, though. If you can, Dr. Neunert recommends working with a specialist like a pediatric hematologist to monitor your baby’s platelet count as you breastfeed and help provide you with any insight you’re seeking.
It’s possible to treat chronic ITP during pregnancy if necessary.
For what it’s worth, most people with chronic ITP won’t need treatment during their pregnancy, says Neil Morganstein, M.D., who specializes in hematology and oncology at Overlook Medical Center’s Carol G. Simon Cancer Center. But if your platelet count falls below a level your doctor deems safe, you might need medical intervention.
Some ITP treatments are generally safe during pregnancy, while others may come with significant risks that you’ll have to weigh against the benefits with your doctor. Doctors will usually first try corticosteroids, which are typically an effective way to boost platelets and a relatively safe option for pregnant people and their fetuses.
Another chronic ITP treatment that experts generally view as safe during pregnancy is intravenous immunoglobulin (IVIg), which involves receiving antibodies from donor plasma. This can boost your platelet level quickly, which makes it an option in an urgent situation.
“While there is always a risk-benefit assessment that goes into medication use during pregnancy, both of these are considered relatively safe and appropriate for use, especially during the second half of pregnancy and as we are planning for delivery,” says Dr. Zuckerwise.