Low platelets (maternal) question about PPH and vitamin K (baby)

[triscuitsmom]

My bloodwork done at 32 weeks came back with a platelet level of 119. My midwife wants to repeat it this week so I'm picking up the requisition today so I can hopefully have the results back by my appointment on Tuesday (I'll be a day shy of 38 weeks then if baby hasn't been born yet).

If it's still that level or lower what are the actual risks for PPH? I am already at higher risk because I've had PPH before although the cause was likely iatrogenic, because we can't know that for sure my midwife would be more comfortable with me in the hospital to birth and with active management of the third stage. I'm trying to get a complete picture of the actual risks but everything I'm reading seems to be either really really scare tacticy or else says there is no problem if it's above 50-75.

If my platelets are low is there a risk to the baby that he will have low platelets as well? Would it something worth considering the vitamin K shot for? We have it down that we are declining the shot but I just want to make sure I'm understanding correctly how my platelets could affect his.

Thanks so much! This is stressful knowing he could be here any day (and in fact after a SROM we really expected him to be here already but it resealed and so I'm still gestating lol)

[turnquia]

Now i'm not an L&D nurse. I'm a cardiac nurse. so keep my opinions in mind.

However a platelet of 119. That's not even something we'd call doctor to notify them about. Its not a critical lab value, especially if you run low. (Normal range is 150-400 ... I always forget the upper limit) So do you know your first CBC results in early pregnancy? If you were low then, or on low end of normal a small drop wouldn't be as much of a concern as if you were closer to 350 and then dropped to 119...

Do you know your platelet count last birth? If so, was it low then?

Are you symptomatic of platelets being low? Nose bleeds? Bleeding gums when brushing teeth, bruising. Either bruising more easily from bumping into things as well as bruises you cannot explain.

We have patients go for surgery with platelet levels at that range. But theorhetically your still at risk. But how much more of a risk is hard to say because it really depends on what's normal for you.

Good luck in deciding what you feel comfortable with.

[mwherbs]

I would recommend giving baby vitamin k for different but related reasons

Vitamin K takes part in the clotting cascade as related to clotting factors II (prothombin),VII,IX,X and anti-clotting factors protein C,S and Z.

Folic acid and B 12 are nutrients more associated with platelets, and they tend to get used up more through pregnancy. There are also certain metabolic disorders that tend toward these deficiencies like autoimmune thyroid disease, and gluten intolerance, either one can also affect levels of vitamin K baby will have, which would be why to give baby supplemental K.
I have consulted with some women who were able to dramatically change their platelet counts thru supplementation, or discontinuation of using a " fiber"
Sponge diet/weight loss supplement and improved eating along with B vitamin with folate supplementation- they used sublingual supplements rather than rely on intestinal absorption working. sometimes use of laxatives can also cause a problem, so that would need to be discontinued. Ideopathicthrombocytopenia
is so intertwined with gluten intolerance in the non-pregnant population that it should be considered even in the pregnant population.

[triscuitsmom]

Thanks for the replies! I wanted to answer/touch on some of your points...

Originally Posted by turnquia

So do you know your first CBC results in early pregnancy? If you were low then, or on low end of normal a small drop wouldn't be as much of a concern as if you were closer to 350 and then dropped to 119...

Do you know your platelet count last birth? If so, was it low then?

Are you symptomatic of platelets being low? Nose bleeds? Bleeding gums when brushing teeth, bruising. Either bruising more easily from bumping into things as well as bruises you cannot explain.

No symptoms of bruising or bleeding. No idea what my platelets were early in pregnancy although I could ask at the midwives on Tuesday if I'm still pregnant because I know they did a CBC because the results for hemoglobin and hematocrit are on my chart (both of those have been fine both at the start of pregnancy and at 32 weeks).

I don't know my platelet count for my last birth but I do know that it was within normal range in my third trimester because they definitely did a CBC at 32-34 weeks just as they did this time and all of my values were normal.

Originally Posted by mwherbs

I would recommend giving baby vitamin k for different but related reasons

Vitamin K takes part in the clotting cascade as related to clotting factors II (prothombin),VII,IX,X and anti-clotting factors protein C,S and Z.

Folic acid and B 12 are nutrients more associated with platelets, and they tend to get used up more through pregnancy. There are also certain metabolic disorders that tend toward these deficiencies like autoimmune thyroid disease, and gluten intolerance, either one can also affect levels of vitamin K baby will have, which would be why to give baby supplemental K.
I have consulted with some women who were able to dramatically change their platelet counts thru supplementation, or discontinuation of using a " fiber"
Sponge diet/weight loss supplement and improved eating along with B vitamin with folate supplementation- they used sublingual supplements rather than rely on intestinal absorption working. sometimes use of laxatives can also cause a problem, so that would need to be discontinued. Ideopathicthrombocytopenia
is so intertwined with gluten intolerance in the non-pregnant population that it should be considered even in the pregnant population.

I don't 100% understand the connection but I am totally willing to learn. Would low B12 be a reason to give vitamin K to a newborn after birth? I definitely have low B12. It was tested a month ago (same time as the CBC for the midwife, only the B12 was part of a blood panel run by my ND). My result was 110 with reference range of 198-615. I've never had low B12 when I've been tested before but obviously something changed.

It's interesting you mention gluten intolerance. Celiac disease runs in my family and both of my boys are gluten intolerant. More food for thought.

[mwherbs]

basically things that would lower your platelets or factors that go into platelet production- absorption of b12 and folate also interfere with vitamin K absorption in mom and so would act on babies both in utero and postpartum where mom is the primary source of vitamin K

[EmTheWife]

I have ITP (idiopathic thrombocytopenia) and it flared up during my pregnancy, with my platelets dropping from 112 at 9wks to 96 at 30 wks, and eventually to 69 at 39w2days when I went into labor. Because of this, it was decided that the hospital was the best place for me to deliver because of the increased risk of PPH. I ended up needing active management for my 3rd stage as I was beginning to bleed heavily, and the active mgt kept me from having a PPH. While the 3rd stage could have been actively managed at the Birth Center, they cannot give blood (if it had been necessary), nor could they have kept us there for 24-36hrs of monitoring. Additionally, it is possible in some forms of ITP for the mother's body to also destroy a number of the infant's platelets, increasing the odds for intracranial hemorrhage (the hospital had a neonatal unit, and a neonatologist attended the delivery in case of neonatal complications). Because of these risks, we chose to give our son the vitamin K shot a few hours after birth, and also had his platelet level checked 24 hours after birth, prior to discharge (he ended up being in the low-normal range).
Best wishes in your decisions!

[triscuitsmom]

Thank you for all of the input!

I had my platelets rechecked a week ago and they actually came up They are 176 now, so within normal range.

I'm still torn on the vitamin K shot so I am going to do some more research on how my very low B12 weighs into that.