Читать книгу Protocols for High-Risk Pregnancies - Группа авторов - Страница 156

Delivery of a pregnancy complicated by FNAIT is generally recommended at 37–38 weeks’ gestational age by cesarean for cases in the medium‐risk category and 35–36 weeks by cesarean for cases in the high‐risk or extremely high‐risk categories. Late preterm antenatal corticosteroids should be considered for deliveries planned before 37 weeks’ gestational age. There is no role for amniocentesis for fetal lung maturity as a part of medical decision making in these cases.

Cesarean delivery is recommended as mode of delivery for pregnancies complicated by FNAIT. For patients who are highly motivated despite this advice to undergo a trial of labor, fetal blood sampling by cordocentesis may be considered shortly prior to planned delivery. Patients should be informed of the possible risk of serious complications with cordocentesis in this setting, and that complications may include emergency cesarean delivery or perinatal loss should severe fetal thrombocytopenia exist. Platelets should be available at the time of cordocentesis should severe thrombocytopenia (under 50 000/mL³) be identified. With demonstration of a platelet count over 80 000/mL³, labor induction is reasonable. Beneath this threshold, cesarean delivery is strongly recommended, even if the fetus has received platelets. Operative vaginal delivery is discouraged in pregnancies complicated by FNAIT.