Gestational thrombocytopeniain pregnancy.pptx

feto

1. Welcome To Morning Session PRESENTER DR. Yasmin Akter Jony Resident, Phase-B Department of Fetomaternal Medicine BSMMU

2. Case No-1 Name-Mrs. Tahmina Age-20 years Obstetric History- Married for- 9 year P-1(VD) + 1 ( sp ab at 8 wks ) Menstrual History- LMP-19.01.2023 EDD-26.10.2023 Diagnosis- 3rd gravida 33wks twin(MCDA) pg with one acardiac fetus with TRAP sequence with GDM( on diet)

3. Acardiac mass

4. Case No-2 Name- Mrs. Fahmida Age- 28 years Obstetric History - Married for 1.5 years Primi Menstrual History- LMP-21.04.23 EDD- 28.01.24 12.03.24 (acc. To 12 wks USG) Diagnosis- Primi Gravida 13wks pregnancy with multile fibroid with newly diagnosed RBBB with antero -inferior myocardial ischemia.

5. Fibroid at fundus

6. Case No-3 Name- Mrs. Sumaiya Age-24 years Obstetric History- Married for- 1 year Primi Menstrual History- LMP-26/11/22 EDD-03/09/2023 Diagnosis- Primi Gravida 40+3 weeks pregnancy with gestational thrombocytopenia with hypothyroidism with CPD

7. Case No-4 Name- Mrs. Urmi Age- 24 years Obstetric History- Married for- 08 year Para – 1 (VD) + 0 ALC -07 years Menstrual History- LMP-10.12.2022 EDD- 17. 09 .2023 Diagnosis-2ns gravida 39 weeks 0f pregnancy with ASD closure with mitral leaflet repair with Rh negative mother with labour pain

8. Case No-5 Name- Mrs. Sabrin Jahan Age- 35 years Obstetric History- Married for- 17 years P- 2(1VD, 1 C/S) + 2 ( sp abortion at 8 and 12 wks ) ALC-3 09 year Menstrual History- LMP-?? EDD-11/10/23 (acc. To 16 wks USG) Diagnosis-5 th gravida with 35+5 weeks pregnancy with Placenta percreta (3C) with H/O Threatened abortion with History of previous 1 CS

9. Case No-6 Name-Mrs. Akhi Age-29 years Obstetric History- Married for- 04 year P-0 + 2( sp ab at 6 and 8 wks ) Menstrual History- LMP-31.12.2022 EDD-07.10.2023 Diagnosis-3nd Gravida 3 5+6 weeks of pregnancy with PE with severe feature

10. Case No-7 Name-Mrs. Rahima Age-28 years Obstetric History- Married for- 12 years P – 1(CS) +2 (sp . Abortion at 2 and 3 month) Menstrual History- LMP-?? EDD-04.10.2023 ( acc to 7 wks usg ) Diagnosis- 4th Gravida 36+5 weeks of pregnancy with Rt sided ovarian tumor with Rt sided hydronephrosis woth hydroureter with GDM(on diet) with history of previous 1 CS.

11. Case No-8 Name- Mrs. Dilruba Age- 27 years Obstetric History- Married for-08 years P-1 CS ALC- 07 y ears Menstrual History- LMP-10.02.2023 EDD-17.11.2023 Diagnosis-2nd Gravida 29+3 weeks of pregnancy with feral congenital anomaly ( Hydrocephalus) with breech presentation with moderate anaemia ( Hb - 6.5gm/dl) with H/O previous 1 CS.

12. Case No-9 Nam e-Mrs. Mahfuza Age- 28 years O bstetric History- Married for- 03 years Primi Menstrual History- LMP- 17/12/ 22 EDD- 23/09/2023 Diagnosis- primi Gravida 38+3 weeks of pregnancy with Dermatomyositis with GDM(on diet) with H/O PTB with H/O paraplegia.

13. Case No-10 Name-Mrs. Borsha Age-21 years O bstetric History- Married for-03 years Primi Menstrual History- LMP-06.01.2023 EDD-16.10.2023 Diagnosis- Primigravida with 35+5 weeks of twin (MCDA)pregnancy With congenital anomaly of one fetus ( omphalocele )

14. Gestational Thrombocytopenia Overview on Thrombocytopenia in pregnancy: Thrombocytopenia in pregnancy has been defined as a platelet count less than 150 x 10 9 /L. It is the second commonest hematologic abnormality during pregnancy after anemia. Incidence: 7–12% of pregnancies. (ACOG 2016)

15. Physiology of platelet Platelets are anuclear fragments, 1.5- 3 micrometer in diameter. Normal range 150-450x109/L Life span is 8-10 days. Megakaryocyte and platelet production is regulated by thrombopoietin , a hormone produced in the kidneys and liver.

16. Formation of platelets: Megakaryocytes are unique cells in the bone marrow, forms platelets by budding of cytoplasm into the marrow sinusoids and extruding them into the circulation. Each megakaryocyte produces about 1000-3000 of platelets. 60-70% of platelets extruded from bone marrow are present in circulation and remainder are mostly in the spleen (sequestrated). Old Platelets are destroyed by phagocytosis in spleen and liver ( Kupffer cell).

17. Large plateiets are more reactive,produce more prothombotic factors and aggregate more easily . They also release more serotonin and Beta- thromboglobulins than do small platelets.

18. Physiologic changes during pregnancy During pregnancy platelet count remain static or there is a general downward drift, particularly during the last trimester. At term the level may approximately 10% less than the pre pregnancy level. Physiologic decrease in platelet count during pregnancy is multifactorial, including- Hemodilution, Acceleration of platelet destruction across the placenta.

19. Causes Pregnancy specific conditions Gestational thrombocytopenia 75% Hypertensive disorders in pregnancy 21% Preeclampsia HELLP syndrome Acute fatty liver of pregnancy Thrombotic thrombocytopenic purpura ( TTP)

20. Causes (cont.) Pregnancy associated conditions Disseminated intravascular coagulation Hemolytic uremic syndrome Pseudo thrombocytopenia

21. Causes (cont.) Not pregnancy associated Primary immune thrombocytopenia Secondary immune thrombocytopenia Antiphospholipid syndrome Systemic lupus erythematosus Viral Infection ( human immunodeficiency virus, CMV, hepatitis C virus, Helicobacter pylori)

22. Causes (cont.) Drug-induced thrombocytopenia (heparin, antimicrobials, anticonvulsants, analgesic agents) Bone marrow disorders (secondary carcinoma, multiple myeloma) Nutritional deficiencies ( Folate/ B12 deficiency) Congenital thrombocytopenia

23. Gestational Thrombocytopenia The most common cause of thrombocytopenia during pregnancy (75%) Affects 5–11% of pregnant women. (ACOG 2016) The pathophysiological process is not known but is thought to represent - acceleration of platelet consumption via an exaggeration of the physiological process across the placenta, or possibly via a mild immune process.

24. Characteristics of Gestational thrombocytopenia The onset occurs in the mid-second to third trimester . Causes mild thrombocytopenia, Platelet count typically > 70 x 10 9 /L and in two-third cases it is between 130-150 x 10^9/L Usually asymptomatic, not associated with maternal bleeding. No past history of thrombocytopenia outside pregnancy. No specific diagnostic test, diagnosis of exclusion. The platelet count rapidly returns to normal usually within 7 days postpartum but within 1–2 months in all cases. May recur in subsequent pregnancies. No associated fetal or neonatal thrombocytopenia .

25. Management options of Gestational Thrombocytopenia Pregnancy and prenatal : Exclusion of alternative diagnosis Maternal platelet count should be monitored(Depend on platelet count , rate of decline and expected date of delivery) No treatment is necessary for gestational thrombocytopenia. Labor and delivery : A short trial of steroid (10-20mg/day) may be helpful diagnostically and therapeutically if platelet count around 50,000-70,000/ cumm . Lower limit of platelet count for safe epidural anesthesia 50,000/ cumm Mode of delivery determined by obstetric consideration.

26. Contd ….. Postnatal: Cord blood sampling should be done if diagnosis is uncertain. Maternal platelet count should be followed postnatally . Rapid return to normal confirms the diagnosis.

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