PPH and low platelets

[LotsOfNettleTea]

Hello :) I'm 3 days overdue with my third child. My platelets have dropped with all 3 and I have been diagnosed with ITP rather than gestational low platelets due to them going as low as 37 when I went into labour with my last son. But I havent responded to any treatment so the consultant has suggested that it'sjust how my body responds to pregnancy and that I may need a platelet transfusion in labour. The worry is that my blood won't clot properly under a certain level. I haven't been too concerned due to my belief that I didn't bleed much with my previous births (levels were around 80 with both thanks to platelet transfusion)but my notes show a PPH of 500ml with my first and a loss of 400ml with my second. Now I'm terrified of bleeding to death :( my first birth was long, induced to speed it up and required an episiotomy but my second was a lot quicker and easier. I'm concerned that it was never mentioned that I hemmoraged. Sorry if that makes no sense, just wondered if anyone had any advice or experience, I'm really worrying myself now when I should be chilling out. Thanks :)

No real advice, but AFAIK the average blood loss during a normal vaginal delivery is 400-500ml, which is probably why no one has mentioned it before. For reference from the point of view of a 'normal' pregnancy PPH, I lost 1.4l in my first delivery and didn't need a transfusion (with hindsight I could have done with one though!) and lost about 1000ml in my last birth (ELCS) and I remember them debating whether to class it as a 'proper' PPH. Hope that helps a little!

I had a pph of 2.5l and I'm about to have baby 2. I've been told that going overdue is dangerous as is induction. I'm booked for section at 39+4. I would talk to your consultant about it as soon as you can.

Thanks both of you :) that does help put it into perspective Hopefully.WorriedMouse, I've never heard that about going overdue, is that because of the baby's size?as far as I know C-section comes with a much higher risk of bleeding than vaginal delivery which is why my consultant wants me to have the latter with my potential bleeding disorder. I suppose its more controlled though.

My reading around the subject suggests that haemorrhage is more likely with CS, and standard bleed is bigger. For me, it was a lesser risk than my horrendous natural delivery, but might be worth asking your consultant about.

Yes you do bleed more with a section but its controlled with very experienced staff. My pph was initially managed by a junior midwife and a recently qualified doctor and probably wasn't handled too well. Knowing I've a team of people and I'm having my baby at a specified time is reassuring. I also know that they will have blood ready should i need it. It was my decision in the end and i decided after the trauma the last time, i wanted a controlled environment. I bled a lot with a vd so i may bleed again at a section. Consultant said at my first appointment at 15 weeks that going overdue wouldn't be a good idea and induction was a definite no.

Good luck!