Idiopathic or immune thrombocytopenic purpura (ITP) is an autoimmune disorder. The antiplatelet antibodies decrease the lifespan of the platelets.  It is often discovered with prenatal screening of platelets on the CBC done in the first and second trimester.

Diagnostic Findings

• Thrombocytopenia

• Capillary fragility

• Increased bleeding time.

Nursing Care

• Control of platelet stability

• Corticosteroids or IV immunoglobulin if diagnosed in pregnancy

• Platelet transfusions

• In some cases, a splenectomy may be needed

Venous thromboembolism (VTE) results from the formation of a blood clot or clots inside a blood vessel and is caused by inflammation (thrombophlebitis) or partial obstruction of the vessel. Three thromboembolic conditions are of concern in the postpartum period:

• Superficial venous thrombosis: Involvement of the superficial saphenous venous system

• Deep venous thrombosis (DVT): Occurs most often in the lower extremities; involvement varies but can extend from the foot to the iliofemoral region

• Pulmonary embolism (PE): Complication of DVT that occurs when part of a blood clot dislodges and is carried to the pulmonary artery, where it occludes the vessel and obstructs blood flow to the lungs

Incidence and Etiology

• Primary:

  • • Venous stasis

    • Hypercoagulation

Clinical Manifestations

• Superficial venous thrombosis characterized by:

  • • Pain and tenderness in the lower extremity

    • Warmth, redness, and an enlarged, hardened vein over the site of the thrombosis

• Acute PE results from dislodged deep vein thrombi. Presenting symptoms are dyspnea and chest pain.

• Other signs of PE include:

  • • Tachypnea (more than 20 breaths/min)

    • Tachycardia (more than 100 beats/min)

    • Apprehension

    • Cough

    • Hemoptysis

    • Elevated temperature

    • Sweating

    • Syncope

• There is no validated clinical prediction rule for DVT in pregnant women.

• Diagnostics to determine PE:

  • • The safety of D-dimer testing during pregnancy has not been validated

    • Echocardiographic abnormalities may be seen in the right ventricular size or function

    • Ventilation-perfusion

    • Spiral computed tomography scan

    • Magnetic resonance angiography

    • Pulmonary arteriogram

Nursing Care

• Superficial venous thrombosis is treated with analgesia, support from elastic compression stockings, heat, and rest.

• DVT is treated with IV anticoagulant therapy, bed rest, affected leg elevated, analgesia. After the symptoms have decreased, elastic compression is used.

• Acute PE is an emergent situation that requires prompt treatment.