Thrombocytopenia In Pregnancy

Multiple Choice

A 28-year-old G2P1 at 32 weeks of gestation presents with a platelet count of 125 × 10^9/L. She denies bleeding symptoms. Her blood pressure is 110/70 mm Hg. She has no proteinuria, normal liver function tests, and no prior history of thrombocytopenia outside of pregnancy. Fetal growth is appropriate for gestational age.

Question: What is the most likely diagnosis?

• Gestational thrombocytopenia

• Immune thrombocytopenia (ITP)

• Preeclampsia

• Fetal–neonatal alloimmune thrombocytopenia

• HELLP syndrome

Multiple Choice

A 39-year-old G3P2 is found to have a platelet count of 60 × 10^9/L at 20 weeks of gestation. In her previous pregnancies, platelet counts were mildly low only at term but normalized postpartum. She currently has no bleeding or bruising.

Question: Which of the following findings in this clinical scenario strongly points away from gestational thrombocytopenia?

• Platelet count of 60 × 10^9/L at 20 weeks

• Normal blood pressure

• Normal liver function tests

• Absence of bleeding symptoms

• Past pregnancies returning to normal platelet counts postpartum

Multiple Choice

Which of the following statements regarding gestational thrombocytopenia is true?

• It typically presents in the first trimester

• It almost always leads to severe fetal thrombocytopenia

• Platelet counts are usually below 50 × 10^9/L

• Diagnosis is one of exclusion with minimal maternal or fetal bleeding risk

• Immediate steroid therapy is required

Multiple Choice

In differentiating ITP from gestational thrombocytopenia (GT), which historical or clinical feature would most strongly suggest ITP?

• Platelet count of 140 × 10^9/L in late third trimester

• History of thrombocytopenia outside of pregnancy

• Asymptomatic presentation throughout pregnancy

• Rapid postpartum normalization of platelets

• Intermittent mild elevation of blood pressure

Multiple Choice

A 35-year-old G1P0 at 36 weeks of gestation has BP readings of 160/90 mm Hg and a platelet count of 95 × 10^9/L. She also has persistent right upper quadrant pain and mildly elevated liver enzymes.

Question: What is the most appropriate next step in management?

• High-dose corticosteroids to correct thrombocytopenia

• Continue expectant management

• Immediate delivery (given severe features)

• Serial platelet transfusions until platelets normalize

• Perform plasmapheresis

Multiple Choice

A 29-year-old G2P1 at 33 weeks is admitted with severe preeclampsia. Platelet count is 45 × 10^9/L. An urgent cesarean is planned due to a nonreassuring fetal heart tracing.

Question: How should her thrombocytopenia be managed before surgery?

• Proceed without intervention

• Platelet transfusion to increase platelet count above 50 × 10^9/L

• Splenectomy

• IVIG

• Uterine curettage

Multiple Choice

In preeclampsia/HELLP syndrome, at what platelet threshold is platelet transfusion generally recommended before a cesarean delivery?

• <20 × 10^9/L

• <30 × 10^9/L

• <50 × 10^9/L

• <70 × 10^9/L

• <100 × 10^9/L

Multiple Choice

Which of the following is not typically associated with HELLP syndrome?

• Hemolysis

• Elevated liver enzymes

• Low platelet count

• Elevated creatinine

• Right upper quadrant pain

Multiple Choice

Which statement is true regarding management of preeclampsia with severe features and thrombocytopenia?

• Medical therapy can cure preeclampsia without delivery

• Platelet transfusions are routinely administered for platelet counts >100 × 10^9/L

• Delivery is the definitive cure for preeclampsia

• Splenectomy is first-line if platelets <50 × 10^9/L

• Steroid therapy alone rapidly normalizes platelet counts in severe preeclampsia

Multiple Choice

A 30-year-old woman at 28 weeks of gestation has a platelet count of 65 × 10^9/L on routine labs. She has a history of ITP diagnosed 3 years ago. She reports mild gum bleeding occasionally. Blood pressure is normal; LFTs are normal.

Question: What is the best initial management to increase her platelet count?

• High-dose IVIG

• Prednisone 10–20 mg/day

• Platelet transfusions

• Splenectomy

• No intervention

Multiple Choice

A 32-year-old G2P1 at 38 weeks has a platelet count of 30 × 10^9/L and a known history of ITP. She desires a vaginal delivery and is requesting an epidural for labor analgesia. No significant bleeding is noted except mild bruising.

Question: What is the most appropriate plan for delivery?

• Immediate cesarean section

• Vaginal delivery is acceptable, but correct maternal platelet count to a safer threshold

• Fetal platelet transfusions in utero

• High-dose IVIG plus platelet transfusion, then immediate induction

• Terminate pregnancy at 38 weeks with no plan for anesthesia

Multiple Choice

For patients with ITP in pregnancy, which initial therapy is generally recommended for mild bleeding or platelet counts below 70 × 10^9/L?

• IVIG as first-line in every case

• High-dose corticosteroids

• Platelet transfusions every week

• Splenectomy

• Aspirin therapy

Multiple Choice

Which statement regarding neonatal management in a mother with ITP is correct?

• Neonatal platelet count usually peaks right after birth

• Neonatal intracranial hemorrhage is common (>10%)

• Intramuscular injections should be delayed until platelet count is known

• Maternal platelet count always predicts neonatal platelet count

• Neonatal platelet transfusion is mandatory in all cases

Multiple Choice

A 26-year-old G2P1 with a prior pregnancy complicated by severe fetal–neonatal alloimmune thrombocytopenia (FNAIT) is now 24 weeks pregnant. The fetus is confirmed positive for HPA-1a, and maternal anti-platelet antibodies are present.

Question: What intervention is most commonly recommended to prevent fetal intracranial hemorrhage?

• Maternal high-dose IVIG therapy

• Urgent cesarean at 28 weeks

• Weekly fetal platelet transfusions

• No intervention until onset of labor

• Maternal splenectomy

Multiple Choice

A 35-year-old with a history of FNAIT leading to neonatal intracranial hemorrhage at 36 weeks in her prior pregnancy. Current fetus is HPA-1a positive. She has been on weekly IVIG since 20 weeks. Cordocentesis at 32 weeks reveals fetal platelets at 45 × 10^9/L.

Question: What is the most appropriate delivery plan?

• Immediate cesarean delivery at 32 weeks

• Continue IVIG and plan vaginal delivery at term if platelet count can be maintained >50 × 10^9/L

• Switch from IVIG to maternal steroids only

• Weekly fetal platelet transfusions until 37 weeks

• Induce labor at 34 weeks

Multiple Choice

Which condition is most commonly associated with severe fetal thrombocytopenia and in utero intracranial hemorrhage?

• Gestational thrombocytopenia

• Maternal ITP

• Fetal–neonatal alloimmune thrombocytopenia (FNAIT)

• Preeclampsia

• Drug-induced thrombocytopenia

Multiple Choice

Which of the following statements about fetal–neonatal alloimmune thrombocytopenia (FNAIT) is true?

• It rarely affects first pregnancies

• It involves maternal anti-RBC antibodies

• It can cause in utero intracranial hemorrhage

• It is less severe than ITP

• HPA-1a antigen incompatibility is uncommon

Multiple Choice

A 31-year-old G1P0 at 34 weeks with ITP has a platelet count of 80 × 10^9/L. She strongly desires an epidural for labor analgesia.

Question: What is the recommended minimum platelet count for safe epidural anesthesia, assuming stable platelet levels and no coagulopathy?

• 30 × 10^9/L

• 50 × 10^9/L

• 70 × 10^9/L

• 100 × 10^9/L

• 150 × 10^9/L

Multiple Choice

A 29-year-old G2P1 at 38 weeks has severe preeclampsia. Platelet count is 40 × 10^9/L. She wants an epidural for induction of labor.

Question: What is the best recommendation regarding epidural anesthesia in this scenario?

• Place the epidural without further intervention

• Increase platelets to ≥70 × 10^9/L before epidural

• Only spinal anesthesia is acceptable at 40 × 10^9/L

• Must use general anesthesia

• Deny any anesthesia

Multiple Choice

Which statement best describes the safe approach to regional anesthesia when platelet counts are borderline low (65–75 × 10^9/L) and stable?

• Neuraxial anesthesia is always contraindicated below 100 × 10^9/L

• Generally acceptable if count is stable, platelet function is normal, and no coagulopathy

• Requires platelet transfusion in all cases

• Only a spinal block is safe

• No data exist on this topic