Thrombocytopenia in Pregnancy: A 5‐Year Analysis of Characteristics and Practices From a Tertiary Academic Center

ABSTRACT Background Moderate‐to‐severe thrombocytopenia (platelet count < 100 × 10 9 /L) occurs in fewer than 1% of pregnancies, posing management challenges, particularly surrounding eligibility for neuraxial anesthesia. Although recent anesthesia guidelines recommend a platelet threshold ≥ 70 × 10 9 /L, outcomes data applying these recommendations in moderate‐to‐severe thrombocytopenia remain limited. Methods We conducted a retrospective study of 306 pregnancy encounters at a tertiary U.S. center (January 2018–December 2022) with ≥ 1 documented platelet count < 100 × 10 9 /L. Etiology, platelet nadir, hematology consultation, treatment patterns, and neuraxial anesthesia (NA) use were assessed from antepartum through postpartum discharge. Results Gestational thrombocytopenia (gTCP) was the most common etiology (29%, n = 92). Thrombocytopenia severity differed across etiology, with higher platelet nadirs in gTCP (mean 84, median 88.5 × 10 9 /L) compared with ITP (mean 62, median 66 × 10 9 /L). Overall, 15% of pregnancies received hematology consultation, the majority of which were for individuals with ITP, and 78% underwent NA. Among pregnancies complicated by ITP, 71% received NA. Hematology consultation in ITP was associated with lower platelet nadirs and higher treatment rates. Conclusions In this cohort of moderate‐to‐severe thrombocytopenia, institutional adherence to guideline‐recommended platelet thresholds was high and associated with excellent neuraxial safety outcomes. These findings provide real‐world support for current anesthesia recommendations in a higher‐risk obstetric population.