IVIg Treatment to raise platelets for delivery

hi all! I've had two previous deliveries without knowing of my ITP and during delivery I lost a lot of blood. My doctor mentioned either steroids or IVIg before delivery to raise my platelets for delivery of my 3rd child. I've tried steroids, dex, and had AWFUL side effects which I really don't want to go though after the baby is born. My count only went up 30,000 with dex.

What are the side effects of IVIg? Which would you choose if you were in my situation? Any thoughts are much appreciated. Thank you.

Hi bocats,

I've taken prednisolone & had ivig before. Never had dex so can't comment on that. I'm currently 38 weeks pregnant & have talked to my haemo about treatment options (I don't need any atm - but just to be prepared).

He would want me on pred as it's fast, cheap & easy to stop after a short term boost. I never had bad side effects so that's my plan.

However, I had no side effects from ivig either. The first transfusion was over 5 days though to check for reactions. I didn't have any so that was reduced to 2 days for subsequent infusions. If you haven't had ivig before it might be over several days - yes it's before birth, but if you have two other little ones to take care of, it might depend on childcare etc. it also only lasts around 3 weeks typically - so you may need something else after the birth anyway? Obviously no one can predict that though.

Personally, I'd pop a steroid & hope it works. But, as you only got to a count of 30ish on them before, ivig might be worth a gamble if you want to put the time in.

When are you due? Did you take anything in previous pregnancies? Your body *could* react differently in pregnancy - I haven't tried any of these treatments whilst pregnant, but steroids worked much better for me when I was on the contraceptive pill - maybe the hormones might help out??

Hope something there is helpful

Hi Katsim,

I'm only 11 weeks pregnant and my platelets were 103 last week which has been pretty normal for me the past year. With my last two pregnancy I didn't have any treatment because we didn't know I had ITP. Which looking back, I can't believe my doc didn't even think about my platelets. I have thought about just going all natural if my platelets drop onto the range of not receiving an epidural.

What was your dosage of pred. while pregnant and for how long? I was on 40 mg of dex for 4 days basically just to see if it would raise my platelets at all. Side effects were awful for me the three weeks after dex!

Dex does have horrible side effects. Most people hate it. Hopefully your counts will stay where they are and you won't have to worry about treating. Congratulations and good luck!

Hi bocats,

I haven't had any treatment this pregnancy - I've been very fortunate!! My counts went up from 30ish before my pregnancy to between 50-100ish for most of my pregnancy.

I hope your counts stay up too!! I have been told that a natural birth with platelets above 50 is fine. For an epidural the count needs to be over 80. My count are currently 74 at 39 weeks pregnant & that 80 mark is non-negotiable. I could take steroids to try & bump it up, but I'm going to try & go without the epidural rather than take pred.

Good luck hun!!! Hope you have a wonderful pregnancy!! How were your other kids births?? Did you have pain relief? What would you like for this birth? That might influence whether or not you treat

Kat:

I had two children without an epidural or any other meds. It was long and hard, but I wouldn't have wanted to do it any other way. If you've never had an epidural, you don't know what you're missing. For me, the thought of a needle in my spine was worse than the pain of childbirth!

Good luck - any time now!

Haha, Sandi I was the same. Couldn't bear the thought of a needle in the spine, tried the gas and air but hated the feeling so gave birth twice with no pain relief. It was all fine.

Breathing helps a lot, that and having someone tell you when the contraction is coming and when it's going away. I'd say that was the main thing!

My first child was born while I was completely asleep. The doctor insisted on putting mother's out totally and I didn't know any better. I was out during most of the labor but woke up in the middle of contractions dazed and not knowing what was going on. That delivery was a nightmare and the worst of my three. I think that's when I decided that being alert was the best way to go if possible.

My second child had to be induced two weeks early because my water broke. That one was rough because I wasn't dilated at all to start with and Pitocin was wicked. Contractions on top of contractions for 18 hours. She was the easiest delivery though, barely had to push at all because they made me wait until I was totally out of transition. That part was worth it.

The third one....got to the hospital an hour before he was born. No time to consider any meds which was fine with me. Easy labor but delivery was a little harder...still not much to complain about.

I wish all of you ladies the best of luck! I hope everything works out the way you want it to, whether you get meds or not.

Hi ladies! Sorry, I haven't been able to get online to check the forum for a few days. It really helps reading everything that you ladies wrote. I really appreciate it.

With baby #1 my platelets were never mentioned to me throughout my entire pregnancy. When I went into labor they were still not very low because there was no mention of not getting an epidural. I bleed a lot with that delivery and passed out about 10 mins after delivery when the nurse was trying to get me up. Blood was checked at my 6 week appt and my platelets were lower than normal. I can't remember the count but not low enough to treat.

With baby #2 blood was check at my first spot with platelets around 120,000. That was the only time was blood was check until delivery. I went into to the hospital with my platelets in the 80'000. There was a lot of talk about no epidural. They checked my platelets again as I progressed and they dropped to 60,000. To my surprise the anesthesiologist gave me an epidural anyways after multiple questions like... Do you gums bleed?, Do you have sores on your mouth?, do you bleed a lot from a cut?, do you have a history of low platelets?... Which they one I did, but I didn't know it. No bleeding after that delivery. It was amazing. My counts slowly got higher but have never returned to the 120,000 range. They have been around 100,000 for over a year. Which I sm totally happy with.

This baby, baby #3, If history repeats itself... My platelets will drop about 50% during delivery. they would put me at 50,000. I will opt out of meds as long as it's safe.

My doc said we could just give my platelets before I get the epidural to make my counts rise just for the delivery process. What is everyone's thoughts on that? Does receiving platelets raise your count temporarily? My hemo has never mentioned this as an option. Thanks for all of the input ladies! I really appreciate it!

Sandi and Ann,

Was ITP something that affected your pregnancy at all? Were you aware that you had ITP at the time?

I did not have ITP when I had my kids, that came later. I told the stories so that maybe it would help someone to know that if you can't get the epidural, you'll get through it okay. Sometimes it's a choice of having to treat if you really want that epidural, or going without treatment to have a delivery without one. That is completely up to you.

Bob, they probably didn't mention your counts the first time because they were not low enough to be a concern. Even if counts are under 150k but still around 90k to 100k, it is still considered safe for childbirth.

Platelets can be given during labor and they may or may not cause the count to go up. Platelet transfusions are so temporary for some people that if counts do go up a bit, it might only last an hour or so. You can't predict what will happen this time based on what happened the last time. ITP can be a crazy thing and it does what it wants.

I had my son 8 months ago and through my whole pregnancy I received ivig three times a week 5 hours a day it sucked but worth every second. Side effects are less then steroids, for me anyway we all take thing differently but my son arrived healthy and ivig got us there hope this helps, good luck