TOPIC:

Hi everyone! This is a pressing issue so I hoped to get some responses quickly!
I am 34 weeks pregnant, almost 35 weeks. I have ITP and my range usually is 60-120,000 but typically lingers around the 80s. So not a bad count. My doctor due to my ITP is wanting to induce me a little early (38 1/2 weeks) and is recommending if I want to consider an epidural I need to get in with my hematologist and maybe start steroids.

She said it is not crucial I get on steroids since my count is OK. But I won't be able to use an epidural if my count is under 100,000. AND if I need a C-section, I will have to be anesthetized completely. IS THAT SAFE??? It sounds scary and baby will likely have to be resuscitated after birth. Yikes.

I am fine with the pain of child birth, it is my first but I know I can do it. So to me, getting on steroids is not a huge deal if my count is still in a safety zone.

Can anyone think of a GOOD REASON I should begin steroids if I am not in a "dire need" for them now? Should I get on them just so my count goes up enough if I DO need a c-section? Is there any risks I am overlooking to my baby, if I let my count stay in the 60s-80s for birthing?

AND -- if I am induced in 4 weeks, IS there enough time to begin steroids if I choose to? The side effects of steroids scare me a little, too. Just need someone to weigh in.

Thank you

At the time of my 2nd daughters birth I didn't have ITP (at least I wasn't diagnosed at he time)but my platelets were low. By low I mean around 100K. I remember them saying I might not be able to get the epidural becasue they were too low. When I went into labor they checked my count and I think I just made the cut off. I got the epidural but it was too late for it to take effect. And really the pain was not that bad. I would ask the obgyn what they think. I talked to my OB when I was thinking of having a 3rd (after I was diagnosed) and they told me they would watch my count throughout the 9 months then just before delivery make sure I was above 100K.

Hope you get the answers you need. Good Luck with everything!

I wouldn't base that decision on the epidural. I've had two natural births and didn't want the epidural. As you said, you get through it.

It's a tough decision. Prednisone can work really quickly (a few days) if you are responsive to it. If not, you get side effects for nothing.

You're doing great and at 35 weeks already! A small taper of prednisone to boost your count isn't the end of the world but I wouldn't do it until a few days before the expected birth (not weeks). I would prefer to do that than go "under" for the birth if there was a choice. Some do epidural at 85K and some at 100K. It's for safety and I guess at the Dr's discretion (comfort level). There are papers describing woman who have naturally delivered babies with platelets ranging from 7K-100k. I thought c-section only needed 50K but to have it awake (eg. epidural) you'd need the 85-100k. Keep us posted!

Hi Texasmum,

Well done, so far, not long to go. Could you not start steroids 1 week before the induction date, then you can have the option of an epidural if need be, and could be awake to met your baby if a c section was necessary.
I had my baby 8 weeks ago, I started on 50mg a week before I was induced and tapered fairly quickly after he was born. I didn't end up having an epidural, but having the option was a great comfort to me after a very painful and upsetting birth experience previously.
Also keep in mind inductions can be more painful than natural labour. In saying that, out of my 3 inductions I only had an epidural with one, the other 2 were drug free.

Keep us posted
Emma

FreshBoarder,
Your platelet count is actually quite good for an ITP person. Like some of the others have already said I really would not base it on the epidural. Women were having kids without any pain meds long before they came along and I think it might be easier to deal with the pain knowing that there is a reason you cant have an epidural. Just be strong, you can do it! I dont quite understand why they want to induce you early with such a good platelet count number. From what I understand you are not at a high risk of heavy bleeding. I ask this because I am pregnant with a platelet count in the 30's and its just becoming a concern during labor. I know a little scary. I also have had more of my share of experience with steriods. I would not recommend them unless you really need them. Steriods are a weird thing and every person reacts differently. If you have a lot of faith in your doctors they do know what is probably best, so find you what they think is the best approach overall. I hope this helps some, feel free to ask me any questions if you like. All I have got is some personal experience but its sure thought me a lot.

HI everyone!!!
So I saw my hematologist, my count was 89000. She prescribed me 20mg of Prednisone 4x a day.. I will be on it until May 25th and she said she feels this is "enough" time to raise my count more, and she would rather start raising it now rather than not have it raised enough by induction date......Her first thought was to start 1 week ahead of induction, but was worried if it didnt respond, we'd not have much time to do anything else.

My OB is still on board with my induction plan, she says it is not just bc the ITP but also she sees sometimes placentas age quickly for whatever reason when there are blood issues...IF all is stable the week of my induction she has said I CAN choose to wait it out. However, her recommendation is to induce and I guess be incontrol of the labor, and I think it might help doing it right when my platelets are highest.

I REALLY was fearful of doing induction with no option of epidural --- not because the pain, but because the small chance I'd need a Csection and if I DID get one, I'd have to be totally asleep, baby would need resesitating and I wouldnt be able to meet her for hours likely.

So for now I am on the steroids and we are waiting for my 38th week, and my hema is checking my levels weekly. She said this dosage is fine for me and would be safe for baby........

I trust my docs.. but of course I do like hearing "personal" experiences.

ALSO: My hema did tell my doctor I can have an epi safely at 60-70k range even... and my OB knows this, however it is not up to her, it is up to the anesthesiologist and they are pretty set in stone. Must be over 100,000k...

That's a high dose - good luck! I hope all goes well for you.

Does it sound too high? Obviously my hema knows her job, but I've never ever taken steroids, and it seemed like alot!! I hope it doesnt have major side effects to me over the next 2 weeks.

Well, I'm sure she knows her job, but that high of a dose may be unnecessary. I thought 60 was horrid. How long are you on the 80?