A diagnosis of fetal and neonatal alloimmune thrombocytopenia (FNAIT) is most often confirmed post-delivery, based on symptoms observed in the newborn. However, in pregnancies affected by FNAIT, the choice of delivery depends largely on the severity of fetal symptoms and the risk to the baby.
While cesareans are the most common choice, there is a lack of evidence backing the assumption that an induced vaginal delivery or a natural vaginal delivery is high-risk.
Factors that affect delivery options in FNAIT pregnancies
While the right to choose the kind of delivery you prefer is an important part of the pregnancy journey, in FNAIT-affected pregnancies the final choice will be based on the risk to your baby. These are some of the factors that might affect the decision:
Fetal symptom burden
Thrombocytopenia or a low blood platelet count prevents the fetus’s blood from clotting, increasing the risk of bleeding or hemorrhage in the brain, gastrointestinal tract, lungs or eyes. The most dangerous symptom of FNAIT during pregnancy is an intracranial hemorrhage (ICH), which can cause long-term neurological and developmental consequences such as intellectual disability, cerebral palsy, seizures and deafness, or in rare cases, death.
If your baby is suffering from a high symptom burden, the pregnancy is considered to be high-risk, and a cesarean will be either planned or performed as an emergency option.
Potential risk of injury during delivery
Bleeding or hemorrhage such as ICH from trauma or injury during a vaginal birth can cause serious complications, which is why vaginal births are avoided in cases where the fetus’s platelet count is very low.
In vaginal deliveries of FNAIT-affected babies assisted delivery methods such as forceps, vacuum extraction or invasive procedures such as scalp blood sampling and scalp electrodes are avoided to prevent birth-related harm.
Previous outcomes of FNAIT pregnancies
There is little scientific evidence to prove that vaginal births are more dangerous in FNAIT pregnancies or that there is a direct link between a vaginal birth and the onset of ICH. However, a planned near-term cesarean delivery is often recommended as the safest option. This is the case for pregnant women with a history of previous FNAIT pregnancies with ICH.
However, if previous FNAIT pregnancies were unaffected by ICH, and if the current pregnancy has proceeded with few complications, a planned induction is considered a safe option.
Your maternal-fetal specialist will assess your situation and consult with your healthcare team before advising you on the best option for you and your baby.
