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She will most likely progress to eclampsia.
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She will continue to have low platelets postpartum which will most likely require steroids and/or a splenectomy.
Her infant will most likely require a platelet transfusion postpartum.
She will continue to be asymptomatic and her thrombocytopenia will resolve spontaneoulsy postpartum.
She will most likely require several platelet transfusions intrapartem.
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The patient in this case has gestational thrombocytopenia. This condition resolves postnatally with no treatment required. Gestational thrombocytopenia is not related to the preeclampsia, eclampsia, and HELLP syndrome (Hemolysis, Elevated LFTs, Low Platelets) spectrum of thrombocytopenic disease. These illnesses are much more severe and present with widespread symptoms. Gestational thrombocytopenia is characterized by mild thrombocytopenia (> 80), otherwise normal labs, and normal counts before and after pregnancy. This is most commonly seen in the 3rd trimester and poses not risk to the mother or fetus. The management of gestational thrombocytopenia is conservative. Gauer et al. describe thrombocytopenic diseases that occur during pregnancy. They report that preeclampsia and the HELLP syndrome present with generalized symptoms. Contrarily, isolated thrombocytopenia is most likely caused by drug-induced thrombocytopenia, immune thrombocytopenic purpura, or gestational thrombocytopenia. Gernsheimer et al. describe effective management protocol for thrombocytopenia in pregnancy. Generally, a mild thrombocytopenia is relatively common in pregnancy. This has relatively no consequences for either the mother or the fetus but may result from a range of pathologic conditions which require closer monitoring and potential therapy. Illustration A outlines the relationship of the thrombocytopenic conditions of pregnancy. Incorrect Answers: Answer 1: This describes preeclampsia. Gestational thrombocytopenia has no relationship to preeclampsia/eclampsia. Answer 2: This describes immune thrombocytopenic purpura. Answer 3: This can be seen with immune thrombocytopenic purpura as anti-Platelet IgGs can cross the placenta and destroy fetal platelets. Answer 5: This can be seen with many disorders but not with gestational thrombocytopenia.
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