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Low platelets, prednisone, VBAC

post #1 of 7
Thread Starter 
I'm 36 weeks pg -- my 10 y.o. son was born at 40 weeks via c/s for breech presentation (I never went into labor or anything).

I'm due on August 10th; my OB is fine with spontaneous (read: not induced) VBAC as long as I don't wait beyond 40 weeks -- then it'd be a c/s. I've made my peace with that, and I don't really have a problem with a scheduled c/s if it comes to that, but...

My platelet count has been dropping precipitously throughout the 2nd and 3rd trimester. They dropped from 96 to 88 in a week, and I'm having my blood drawn again today. Most likely, the OB will want to put me on prednisone over the next couple of weeks to bump the platelets back up. Then they'll draw blood again after a week to see if it's working. Apart from the fact that I'm *really unhappy and freaked out* about going on the prednisone -- plus, I can't get a clear picture of what impact it may have on the baby over a two-week period, and whether I'll be able to nurse him as soon as he's born -- I'm trying to get a picture of what to do if the pred doesn't work. Stop it after a week, I suppose.

Anyway, the baby is head-down. I'm a good candidate for VBAC; my current thinking is that I ought to try for VBAC with no drugs -- but will that be hindered by the prednisone? It seems like I wouldn't be in tip-top physical condition for laboring. Should I refuse the prednisone and put my effort into VBAC with the knowledge that if it's not successful I'll have to have a c/s under general anesthesia? (I'm terrified of that outcome, btw.) Should I take the pred (assuming it works), and try for VBAC with the knowledge that at least I'd be awake if it came to emergency c/s (although I'm not thrilled with the notion of an emergency c/s, either)? Or take the pred and if it works just go for the scheduled c/s with the assumption that I'm won't be in any condition to labor? Ugh!

Mostly, I wanted to vent. I need to talk to my OB on Monday about the various possibilities, but if any of you have had experience with this or know someone who has, I'd appreciate your sharing.
post #2 of 7
I don't have experience with your particular condition. But, because of an autoimmune disease, I was on pred for over 7 months. I started out on a REALLY high dose (30mg) and reduced from that point very slowly.

When dh and I started considered TTC #2, we saw my list of dr's and all were okay with conceiving while on pred. (I also nursed ds1 while taking it too - he was 19 mos at the time and nursed about 3xday).

Depending on the dosage, you may find that sleeplessness (this would be a higher doses) is common and taking early in the am would reduce that side effect.

Honestly, in your situation, I don't know what happens if you refuse the pred. Will the dr still let you VBAC? Will it be an automatic c/s? Will you be put on pit to avoid hemmorrage?

But, if taking pred could allow you to VBAC and avoid pit until after delivery, I would definitely consider taking pred. And, I would be willing to take it for the full 2 weeks - even if the results are minimal after the first week, because it does take time to increase your platelets.

GL mama!

ETA - oh, pred shouldn't interfere at all with nursing immediately. I've already talked to my dr about it and the lc at the hospital (since going back on pred after delivery is a real possibility for me) and they both feel comfortable with it. Dr. tom Hale and his book "Medications and Mother's Milk" is a good resource for sighting info about pred and bf'ing if you find the need to defend your choice.
post #3 of 7
Quote:
Originally Posted by DigitalSuze
Anyway, the baby is head-down. I'm a good candidate for VBAC; my current thinking is that I ought to try for VBAC with no drugs -- but will that be hindered by the prednisone? It seems like I wouldn't be in tip-top physical condition for laboring.
I don't know anything about platelets (do you have some pre-existing health problem that's causing that?), but I was given four steroid shots prior to birth (over two days), and they didn't have any effect on me physically (they were to help mature baby's lungs quicker). I was also on magnesium sulfate for 4 days, which totally messes with your body - weakens your muscles, makes you feel cruddy, etc. I labored just fine. Just had trouble walking later that night because of the mag still leaving my system, so I had to have the nurse help me to the bathroom in the middle of the night. But other than that, it wasn't that bad.

The big red flag I was noticing about what you said was that your doctor wants to schedule a C-section after 40 weeks. WHY?!?!? The first C-section was due to breech presentation, not "big baby" (and the big baby thing is usually a crock anyway). I see no medical reason to schedule a C-section if you go past 40 weeks. None at all. There is nothing in your history to suggest that you couldn't have a vaginal birth just like any other woman who has never had one (including first time moms).
post #4 of 7
Thread Starter 
Quote:
Originally Posted by peilover010202
Honestly, in your situation, I don't know what happens if you refuse the pred. Will the dr still let you VBAC? Will it be an automatic c/s? Will you be put on pit to avoid hemmorrage?
I'm doubt that refusing the pred is a realistic option -- and I probably won't. Your comments about the pred have put me much more at ease -- thank you!
post #5 of 7
Thread Starter 
Quote:
Originally Posted by boscopup
I don't know anything about platelets (do you have some pre-existing health problem that's causing that?)
At this point, my condition appears to be gestational thrombocytopenia, i.e., purely pregnancy-related. I've never had symptoms of ITP previously, but I guess they'll track my platelets for awhile after I give birth to make sure there isn't some other root cause.

Quote:
Originally Posted by boscopup
The big red flag I was noticing about what you said was that your doctor wants to schedule a C-section after 40 weeks.
Yeah, I suspect it is the "big baby" myth, combined with the fact of the previous c/s, that I'm borderline for gestational diabetes (I failed one hour of the test with flying colors, and was right on the edge for another hour), and "advanced maternal age" (37, ha!). I'll admit that it's a battle I've chosen not to fight hard because although I'd prefer to VBAC, a scheduled c/s when it's late in the pregnancy doesn't alarm me. I'm just trying to figure out how this new wrinkle affects my options, if they even exist.
post #6 of 7
I am not sure why they are so concerned with your platelet count as most people due not have any problems with a low platelet count until it is below 50 and quite often people are problem free even with it below 20. My count is currently at 72 (was 198 at start of pregancy) and my OB is not concerned at this point and I am almost 38 weeks.
Can you ask why the need for prednisone at this point? Also, know that platelet counts can bounce up and down so hopefully your's will go up
I also have ITP and did in my last pregnancy and it did not cause any complications and I did not require any interventions. I was considered high risk throughout pregnancy but that is about it.
Hope you get some answers and the birth you are hoping for.
post #7 of 7
Thread Starter 
I thought the same thing, based on my research. Apparently, some anesthesiologists won't administer a spinal or epidural to someone whose counts are below 100 (or 90, or 80. Depends.) because of the risk of hematoma. From what I can gleen, the risk is pretty small, which makes me suspect it's more of a malpractice issue than anything else.
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