TOPIC:

Hi everyone. I'm April and I'm due in August with my second child, a boy. I was diagnosed with ITP in April 2008 when I was 31 weeks pregnant with my first child. Quick back story for that pregnancy and delivery: Platelets ranged from about 50,000-70,000 through the last weeks of the pregnancy after I was diagnosed. Platelet count when I was 7 weeks along was 118,000, but I guess since they were a high low no one thought to recheck. I had IVIG at 36 weeks and platelets were in the 60,000's then. I was induced a week later at 37 weeks (was sick with a virus and borderline pre eclampsia) and platelets were 52,000. So no epidural. 22 hour labor. 9.1 ounce baby girl. No complications. Day after delivery I think I was at about 40,000, but then they rose from there. While not pregnant I seem to range from about 70,000-90,000.

This pregnancy I started out around 67,000, but have been sick a lot. Stomach virus, cold, sinus infection and those were all back to back to back and kept my platelets in the 27,000-35,000 range. I'm hoping that now that I am well my counts will resume back to how they were with my first pregnancy, but I also know they may not. I am NOT symptomatic so even at 27,000 I haven't done treatment. I also have type 1 diabetes so steroids are not a great option for me. The plan right now is to do IVIG at 36 weeks.

HOWEVER I've been browsing the boards and doing some research and keep coming across lots of cases where the patient got IVIG and/or platelets during delivery to avoid complications. That was never even mentioned to me with my first pregnancy or this one and I am wondering why. I plan to bring it up to my HEMA and OB soon, but also want to be prepared to discuss it further with them beyond a simple question. It seems like it couldn't do anything but help.

I'd appreciate hearing your experiences with labor and delivery as far as this goes. Thanks in advance!

I have a few weeks to go but will be happy to keep you posted! I'm DUE May 30 with baby #2 a boy. Counts have been 3,000 to 149,000 and currently am at 83,000 (I received IVIg Friday).
Congrats on your pregnancy and here's to health!!

AHT:

IVIG during delivery wouldn't do much because it doesn't raise counts that quickly. Platelets might work, but there isn't any guarantee. Ideally, treatment should be done before the due date. If there isn't any response, platelet transfusions during delivery would be the option.

It depends on how you respond to IVIG. I respond fairly quickly--within a few hrs my coutns start to rise. I delived Sat. When I was in labor my counts were 42. I got to the hospital and was admitted given 2 1/2 units of platlets, 125mg of sodium medrol and IVIG. This all started at about 10:30 in the afternoon. By noon my counts were almost 80 and the anastesiologist decided that if I could get above 90 he would attempt and epidural. A few hrs later I was at 92 and got my epidrual. The platelets were to help if I had any active bleeding, and the steriods and IVIG to make sure my counts were up. I recieved IVIG 2 more times one right after delivery and the next round the next day. My counts were at 66 when I was discharged. I am still on the prednisone but am tapering off.

I think the key is having an OB and hema who can work well together. My hema and OB both happened to be on call that weekend---it worked out perfectly. My hema and OB were both proactive in making sure my counts were up and that both me and the baby were healthy. I am so thankful for both of my doctors who were at the hospital all day and into the next morning making sure I was monitored correctly and that nothing was missed. My hema has been the greatest and he spoke to my OB and told him you worry about the baby and Ill worry about her.