Gestational thrombocytopenia and induction

[Alpinedreamer]

I've read almost everything I can find on the web about gestational thrombocytopenia (low platelet count brought on by pregnancy) but there is very little and even less about other people's experiences. I guess this is because it's reasonably rare (about 7% of pregnancies so I have read). I developed this condition at around 32 weeks but otherwise am fit and healthy.

Does anyone else have any experience of this condition that they might be willing to share? My story is below.

I am now at 41 weeks with a platelet count of 101 and have been told that the hospital want to induce on Sunday rather than waiting the full 42 weeks (which is normal hospital policy). We saw the consultant obstetrician at 39+2, when my platelets were at 100 - subsequently they went up to 109 and then down to 101. She said that given this affects only me and not baby and that the risk factors only really kick in post-birth, there is no reason for things not to progress "normally". The only exception to that would be if my platelets took a sudden tumble, in which case they might want to induce early before they fell any further.
The general premis seemed to be that anything which increased the likelihood of bleeding would be a bad thing and therefore they would think twice about any form of intervention. The cutoff point is a platelet count of 80, below which they will not do an epidural/spinal. If that becomes necessary, "anything surgical" (which I presumed to include forceps etc) would be done under a general anaesthetic. Clearly, they try to avoid that wherever possible.
However, I've now had a call from the hospital to say that another (more junior) doctor saw my last platelet count (of 101) and has decided they want to induce at 41+4 rather than at 42 weeks.
My platelets have been yo-yoing around 100 (but never below) for about 6 weeks. So I don't understand the change of tack here.

Anyone else any experience of this? I'm going to talk to this new doctor tomorrow to question this change of tack....

[deardoctor]

Alpine given it is only 3 days different is it possible they are rearranging for their own theatre availability / ward spaces etc.?

I have a different clotting disorder which means I can't have epidural / GA etc. within 24 hours of my last blood thinning injection which has to be done daily. In my last pg was told not to do the injection if I felt I was at all likely to go into labour and they planned the induction for 39 weeks. Happily my waters broke at 38 weeks so I didn't have to play the 'guess how likely' game or have a time limited induction!

I too am slightly suspicious of the recent change of tack, especially seeing as your levels haven't really changed since 39+2. Is it possible that he just saw the last 2 results and thought 'uh-oh her levels are dropping?

[Alpinedreamer]

deardoctor, I fear you might be right. This makes me very angry that they are prepared to intervene (and risk all sorts of other procedures being necessary) just to suit their own timetables. A number of friends have also suggested this to me. I know (hope,assume??) they mean well but it's this kind of decision which undermines my trust in them. I don't know anything about the doctor this decision has come from, either (it was the hospital midwife who phoned me) or how many results they've seen. My levels haven't really changed very much at all in 5 weeks. I will chat to them this morning and will decide for myself whether their reasons are valid or not. They will do some monitoring today too, to check everything is ok. Assuming it is, I think I'll just say "I'll wait a bit longer, thanks". If I don't consent, what can they do about it!?!

[dcb]

If it's only a few days difference, why not just get on with it? If it was me I'd prefer that.

Even tho' the Doctor that has suggested this is more junior than a consultant, they are likely to be a registrar and will probably have discussed it with the consultant. I doubt that they would get you in on a Sunday unless they felt it would benefit you - would usually try to keep it Mon-Fri.

[deardoctor]

I would guess she doesn't want to 'get on with it' because she is hoping to go into labour naturally. Sometimes induction can be painful and prolonged. Although I had a drip for augmentation in one labour and it was all absolutely fine. Definitely have another chat with them today and find out just how junior the doc is, ask for a 2nd opinion if necessary. There's that whole BRAIN thing isn't there, what are the benefits, risks, advantages of this decision, do I have all the information I need to make the decision, what happens if I do nothing..

Let me know how you get on.

[Alpinedreamer]

Deardoctor, you're right that I don't want to just "get on with it". I've spent 9 months getting my head around how this is supposed to be a natural process and that intervening (while it has it's place, clearly) is not always the best course of action. We did see a consultant today (yet another one) and everything was fine. They were happy to wait a bit longer, asked me what I thought etc, was fine with the idea that I thought my dates were a bit early anyway. And then the blood test result came back with a platelet count down to 89 and the consultant isn't happy. This is the biggest drop yet. They tried a sweep this morning which wasn't possible - everything is still too tightly closed up (I probably could have told them that - it just doesn't feel ready, no matter how fed up I am). So we have reluctantly agreed to induction on Sunday morning. And here I am at 2am, unable to sleep and crying my eyes out because this is so far removed from the way I wanted things to be.I feel frightened and backed into a corner by statistics, which I have no way of knowing what bearing they really have on me. I have no idea where to go from here, whether to go against the medical advice, listen to my body and wait, or whether to just dig deep and bear whatever horrors induction might throw at me? I still have 48 hours for things to kick off on their own....

[dcb]

I'm so sorry you are feeling this way. Perhaps you could try to think about it from a different perspective? About what outcome you would like (healthy baby) rather than the process. Also, you may still end up with the sort of birth you would like even despite having an induction.

I know that I certainly see things differently than I used to - am expecting my third dc by ELCS next week - and I'm probably feeling quite emotional at the moment. I apologise in advance if my replies upset you - not my intention at all.

We lost our ds aged 2 weeks following the devastating effects from an interuption to his cord blood/oxygen supply during a normal delivery. Everything at the time seemed perfectly normal and it couldn't have been predicted or prevented at the time. However, in hindsight, I did have a difficult birth with dd and could probably asked for an ELCS last time. I know no-one could have known what was going to happen and we were incredibly unlucky, but I always think if only... I was really keen to have a natural birth and even tho' I did consider asking for a section this was more important to me.

I obviously feel very differently this time round and am going along with the advice of the obstetricians. The outcome is all we are thinking about.

Sometimes it helps to hear from a different perspective. Good luck and wishes to you.

[Owlingate]

Right its deardoc a minute (can't be bothered to change back. Not a doctor either by the way). Given that the levels actually have now dropped I think its worth taking medical advice. Everything I've found on tinternet suggests your condition is not dangerous for baby but you need your blood to be able to cope with birth and the after effects. And its below a hundred that's the problem and yours is now below 100.

So a few points on induction - the cervix might be all closed up now but things can change at any point. DC1 I was scanned the day my waters broke and his head was free and clear, cervix tightly closed blah blah - I went in to labour with him that night a tad early.

Secondly induction - I was augmented with the drip after my waters broke and nothing happened - I had the epidural put in before the drip and had the smoothest most lovely labour - 4.5 hrs and let the epidural wear off before pushing so no probs there. I also know lots of people who've had one lot of pessaries and gone in to labour straight away. It is just as likely if not more likely that you will have this good experience than those people who end up with loads of intervention - we just hear more from those people.

Have you got any calming / hypno type CDs that work on you? I was like you crying and hysterical when they told me I would have to have the drip because all I heard was that inducing = loads of probs. DP calmed me down but if you've got the hypnobirthing gear it might help you.

Sorry for the essay and sorry that your levels have dropped.

[Alpinedreamer]

dcb, I am so sorry to hear of your experience. I have no idea how that must feel, but I see how you would come to your point of view.
I've calmed down a bit now and read some more positive stories about induction. The night in hospital is not going to be fun (I hate hospitals and I never sleep well in strange places - 15 years in hotels has taught me that). I've been on the hypnobirthing road since day 1 and was hoping to avoid an epidural anyway. The only bit I'm missing is the pool. So I think you're right that the thing to focus on is the "normal" bit, dig deep and hope that all I need is the help getting started. I've still got 36 hours for things to kick off on their own anyway, maybe that will help me sleep tonight.
Thanks for being a sounding board. Sometimes it helps to rant with people you don't know more than with people you do!

[Owlingate]

Hey Alpindreamer hoping you're in labour or feeling more relaxed and excited about tomorrow. Let us know how it all turned out.

[Alpinedreamer]

Hello again. Seems like ages since I wrote all the above! Just to let you know what happened. My worst fears were realised. We went for the induction under some pressure from two different consultants. Things started happening within 2 hours of having the pessary (great!). That was noon on the Sunday. We spent the night in a curtained cubicle in the hospital and on Monday morning they said the pessary had worked well, took it out and said they would skip the prostaglandin gels and find a space for us on the labour ward, break my waters to keep things moving and that would be fine. They didn't find a space for us until 7am Tuesday by which time I'd had regular contractions, and getting stronger, for 9 hours. I was utterly exhausted having survived two nights without sleep on just paracetamol and tramadol. I was told we were "too high risk" to be allowed home for the first night, where we might have been more comfortable at least. It still isn't clear to me what risk they were running in letting us go home. The second night was just waiting to move wards and nothing happened. The midwife on duty spent much of the night with her head on her desk asleep. 24 hours of TENS machine left my back numb. It was causing rather than relieving pain so I took it off.

To cut a long story short, I then had an epidural, my waters broken, 8 hours of the syntocinon drip, a temperature, antibiotics and ended up with a c-section at 23.00. The experience was about as far removed from what I wanted, hoped for and worked for as it could possibly be and while baby is big, healthy and happy, I am left feeling traumatised and damaged. Granted, things may have turned out this way anyway since I just didn't dilate sufficiently. But being flat on my back for the whole of Tuesday did not help one little bit. It's all very well saying stick to your guns and have what you want, but it seems to me that one can very quickly reach a state of confusion and exhaustion which makes such assertiveness almost impossible. That was me.

To top it off, both of us are now suffering from thrush as a result of the antibiotics I had. We're managing the feeding but it's pretty painful. With the c section I am pretty housebound for now and cabin fever is setting in. Not good for someone used to being outdoors and never sitting still. I can't do much for myself, I'm left with a numb leg from the epidural and various other things just don't work like they should. I don't know how much will improve with time and nobody seems to be able to tell me.

I spent the first week in tears about all this. Now I am slowly coming to be angry about it. We have an appointment with the consultant to discuss what happened and why (feedback for them, catharsis and maybe greater understanding for me). I am also seriously considering counselling if only so this doesn't eat away at me for the rest of my life. I am blaming myself as much as anyone for not sticking up for what I wanted and believed in and what I wanted for my child. Anyway, life goes on and we have plenty of new things to enjoy and to get right!

[Lynzsy]

Hi just saw your message about your traumatic experince, hope things have got better for you, I went through a very similar experience with my thrombocytapenia, with my 1st son they let me go 2 weeks over I had 4 gels that all failed, that night I was told by a doctor that I was going down the next morning for a c-section and that there was a 50/50 chance of me coming through the operation alive, well it turned out my platelets had dropped to 68 I had a general anaesthetic, when I came around I could feel where they operated and was in agony they put me on oxygen and a morphine button, I then went on to have gallstones which I had trouble with while still in their care they completely ignored my concern, my midwife got me in touch with the consultant I complained to him and he said that he was sorry but he had to do what he did because it was the only way to deliver the baby safely, I now have a second child and I had thrombocytapenia again only this time I saw a blood specialist who was amazing and my second child was born with a platelet count of 100 by spinal block and I got to see him straight away because I was awake this time, I've been told that I will have this problem with every pregnancy I go through, my son is now just over a year and I couldn't be happier with my 2 boys, I do think that women with this problem during pregnancy should be better informed and have better after care, I'm glad that your little one is ok and I really do hope you are doing well and on the road to recovery .