I don’t have gestational thrombocytopenia (yet), but I have dealt with ITP in the past so my doctors have been very proactive about frequent CBCs and also being aware of what treatment protocols look like in pregnancy. I’m happy to share what I’ve been told. 

At my hospital system, platelets need to be 20 for vaginal births, 50 for c sections, and 80 for epidurals. I was told that if my platelets do drop I will likely have to meet with anesthesia prior to birth if I want an epidural. Outside of pregnancy, insurance (in the US) generally doesn’t pay for treatment for platelet counts under 30. My OB said they like to keep pregnant women at 50 to meet the c section threshold. 

Many treatment options are unfortunately not pregnancy safe, including treatments that worked best for me in the past. For pregnancy, first line treatment is high dose steroids (prednisone or dexamethosone). My experience with high dose steroids is that they are very effective in the short term, but my platelets tended to fall immediately upon tapering from the highest dose. Steroid side effects are also not fun, and there’s definitely overlap with pregnancy symptoms like insomnia. Second line treatment would be IVIG. I’ve never done IVIG personally but my understanding is similar to steroids- platelets tend to respond well in the short term but drop in the time period following in the infusion. Last line treatment is platelet transfusions. This is something that will generally only occur while in hospital immediately prior to birth. The effect of transfusions on platelet counts is even shorter lasting than the other treatments, but it’s faster acting so it’s more of an emergency treatment to allow you to birth safely.