Low Platelets - need advice!

Hi everyone,

I'm 30 weeks 5 days pregnant with mono/di twins. About a month ago I was diagnosed with low platelets (they were 102,000). My OB ordered another blood test for me in 3 weeks and at that time they were 98,000. My liver enzymes were also checked and HELLP was ruled out. My OB also told me that most anesthesiologists get nervous when platelets drop to 60,000. But after lots of Google research, which really just scare me more than anything, I found that 50,000 - 60,000 is where they want you to be for a vaginal delivery. For c-section (which is a must for me - one baby is breech) I found that you need to have your platelets over 80,000.

My peri wants me to deliver no later than 36 weeks and I'm afraid I'm going to drop below 80,000 by that time. And if I do, I'll have to be under general anesthesia for the c-section and my hubby won't be able to be in the OR at all. That sounds like an awful experience and I want to avoid it at all costs. I think I'd rather delivery early to avoid it.

Has anyone been through this? Can you give me some advice?

Should I be asking for steroids for the babies lungs in case I have to deliver early?

 

I have had thrombocytotenia (gestational low platelets) for my last 4 pregnancies. Normal range is 350,000-450,000 in women. One of the many things people, and dr's, do not realize is that this is actually really common and though platelets are low in some due to the massive increase in blood volume during pregnancy they actually grow in size and become very large. So, the ones you do have are much, much larger than average. My midwife and her backup OB did lots of research on it and this past July or Aug a medical journal report was actually published that stated they are now finding that platelets do not become dangerously low in pregnant women until 20,000 due to how large they are in size. Something to defniitely ask your dr about.

Also, one of the things we did have good experience with in this pregnancy to get them up was taking Nature's Sunshine ionic minerals, alfalfa capsules and barley powder. Once I started that routine they have surprisingly hung around 90,000 to 128,000....which is exceedingly high when compared to my last 3 pregnancies and the beginning of the 2nd trimester in this one.

And it is always possible for one baby to turn!! For us, with our 1st set, B kept turning right up until the day I delivered at almost 40 wks...and he was the bigger baby!

 

:hug: i'm so sorry that you're facing a difficult decision. i agree that it would really suck to give birth under general anesthetic but, for me, i'd rather have a c-birth under general anesthetic if it meant having my babies cook a bit longer. at this gestation, every extra day in is awesome for the babies. and will honestly make your life that little bit easier after they arrive.

i also agree with PP that a lot can still change between now & then. it's a good idea to ask your doc lots of questions & understand what your options are, but i don't think you'll need to make and/or stick to any decisions yet.

i would definitely ask your doc about what they think about the steroid shots & why they would or wouldn't give them.

 

Sorry I messed the previous post up... here is what I had try to say:

Is baby A or B breech? If baby A is head down and B is breech your Dr still could deliver vaginal if they are comfortable. I would find that out. My Dr will deliver vaginal as long as baby A is head down. But there is still time and room for change of position. Also, could you have a platelet transfusion to up them if your Dr is nervous? Maybe a family member could donate? I don't know how that works... just a thought! Best of luck to you!
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I actually had HELLP syndrome with my twins. My platelet count was 40,000. I had to have two platelet transfusions to bring the count up high enough for my c-section which was done under general anesthesia (I was scheduled for a c/s the following week.) It wasn't easy, but it was what was determined to be best for us at the time. I actually ended up under general for my delivery with Liam as well, but for different reasons.

:hug: Hope you are able to get the delivery you are hoping for.

 

I agree with momof6. With our 1st set it was B that was breech for us and he was delivered that way. It is possible to deliver vaginally if B is the breech one. I'd definitely keep those babies cooking. One thing I have found having had this issue with 4 pregnancies now is that the number can vary drastically from week to week. In one pregnancy they were 71,000 one week and the very next appt 2 wks later it was up to 110,000. THey then dropped again after that and continued to fluctuate until the end. It's a roller coaster ride with the numbers but know that they do not always continue to take a downward spiral. Definitely ask your dr lots of questions and ask about the size of your platelets and how they compare to average size. I agree that it would be no fun to be under general anesthesia to deliver babies.

 

General anesthesia delivery isn't optimal, but ITA with Rachel- they need all the time in you they can get. If that's what it means, it's way better for them.

I'm sorry you are going through this, though. :hug:

 

I had low platelets throughout- not super low, but low enough to be monitored and that it was a delivery room decision. I had a 36 week c-section (due to low amniotic fluid and slowing growth) and the anesthesiologist was kind of on the line about it. My doctor felt it would be okay so we went for it. They said I lost more blood than they expected, but it wasn't so bad that anything special had to be done. Good luck. I would be a little surprised if your doctor was okay with taking them earlier- 36 weekers can be pretty small. I wish we had made it even one more week although they were and are fine. They were about 4.5 lbs each and had 9 days in the nursery.

 

Thanks for your replies everyone! They were very helpful.

This is sort of a different type of question, but my peri says no longer than 36 weeks because the babies are sharing a placenta. Has anyone else had a doc recommend that? All he told me was after 36 weeks the risks of harm to one or both babies outweighs the benefits of an extra week in utero.

 

my girls are mono/di & i was told the same thing by my OB. i didn't agree with her & would have argued for additional monitoring rather than an elective delivery, but it became a moot point when the girls came on their own at 34w1d.