Complications of pregnancy: immune thrombocytopenia: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Complications of pregnancy: immune thrombocytopenia

Sample item

A woman at 14 weeks, known since adolescence to have an isolated low platelet count of about 60,000 per microlitre, has no bleeding and a normal blood pressure. Her peripheral smear is otherwise normal. What is the best management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Observation, steroids or IVIG if counts fall

Immune thrombocytopenia that pre-dates pregnancy is managed by monitoring. Treatment with prednisolone or IVIG is started if the platelet count falls below about 30,000, or if bleeding occurs or delivery approaches. Platelets are transfused only for bleeding or before surgery. Maternal IgG antibodies cross the placenta and may cause neonatal thrombocytopenia.

Option by option

  • A. Observation, steroids or IVIG if counts fall (correct)

    Correct. Asymptomatic stable counts are observed, and steroids or IVIG are used if they fall or bleeding occurs.

  • B. Splenectomy during the second trimester of pregnancy

    Splenectomy is reserved for refractory cases and not offered routinely in pregnancy.

  • C. Termination of the pregnancy on medical grounds

    The condition is not an indication for termination.

  • D. Immediate prophylactic transfusion of platelet concentrates

    Prophylactic platelet transfusion is ineffective in the long term because antibodies destroy the platelets.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is A, Observation, steroids or IVIG if counts fall. Immune thrombocytopenia that pre-dates pregnancy is managed by monitoring.

Why is "Splenectomy during the second trimester of pregnancy" not the answer?

Splenectomy is reserved for refractory cases and not offered routinely in pregnancy.

Why is "Termination of the pregnancy on medical grounds" not the answer?

The condition is not an indication for termination.

Why is "Immediate prophylactic transfusion of platelet concentrates" not the answer?

Prophylactic platelet transfusion is ineffective in the long term because antibodies destroy the platelets.

What concept does this question test?

It tests Complications of pregnancy: immune thrombocytopenia in OBG. Treatment with prednisolone or IVIG is started if the platelet count falls below about 30,000, or if bleeding occurs or delivery approaches. Platelets are transfused only for bleeding or before surgery. Maternal IgG antibodies cross the placenta and may cause neonatal thrombocytopenia.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Complications of pregnancy: immune thrombocytopenia?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.