Emergency caesarean section with severe thrombocytopenia (8000/mm3)

Abstract

Thrombocytopenia is defined as a blood platelet count below 150,000/mm(3). It is the most common hemostatic abnormality in pregnancy. The risk of thrombocytopenia during pregnancy is 6-15%. The most common causes of thrombocytopenia are benign gestational thrombocytopenia (79.5%), pre-eclampsia (16%), HELLP syndrome (2.5%), immune thrombocytopenia (1%), and hepatitis C (1%). In this case report, we present a 37-week pregnant woman diagnosed as immune thrombocytopenic purpura (ITP), in whom emergency caesarean was performed due to fetal distress despite platelet levels as low as 8000/mm(3). A single liveborn male infant of 2560g weight and 40 cm length with an Apgar score of 8/10 was delivered. No complications were encountered during the operation. Her platelet count returned to normal levels after steroid treatment (methylprednisolone: 2 mg/kg for three weeks and then 1 mg/kg for three weeks). The case was diagnosed with ITP. The etiology should be determined and treatment should be planned in pregnant women with thrombocytopenia. With failure to act promptly and accurately, maternal and/or fetal morbidity, even mortality, may occur. In the literature, it is rare to perform caesaean, even any surgery, in cases with a platelet count below 10,000/mm(3). In this study, we aimed to show that a caesarean can be performed in cases with a platelet level of 8,000/mm(3) when the life of the fetus is at risk.