Immune thrombocytopaenia in pregnancy: Key principles for the midwife
Midwives are professionally accountable for detecting deviations from the norm in pregnancy, and initiating referral to an appropriate practitioner. They must work across professional boundaries, particularly where complex conditions require the involvement of doctors, such as immune thrombocytopaenia (ITP) in pregnancy. Most pregnant women with ITP have good outcomes, with only a few requiring first-line treatment. However, close monitoring of maternal and fetal wellbeing are required and appropriate management is crucial in reducing the risk of associated complications.
Midwives are experts in the care of normal pregnancy/birth, but are also professionally accountable for detecting deviations and initiating immediate referral to an appropriate expert (Nursing and Midwifery Council (NMC), 2012). Although the scope of midwifery practice does not include medical diagnosis, as front-line carers, midwives are well placed to make appropriate assessments regarding the health of pregnant women (Chief Nursing Officers of England, Northern Ireland, Scotland and Wales, 2010). Further, it is essential that midwives build a relationship of trust with women and work in partnership, sharing information and consulting regarding their care (NMC, 2015). Care should be tailor-made, offering choices and a service that delivers personalised and safe care for all women and their babies (National Maternity Review, 2016). Midwives are also required to work across professional boundaries (Kirkup, 2015), especially where complex conditions require the involvement of doctors, such as immune thrombocytopaenia (ITP) in pregnancy. Multidisciplinary working is also key to ensure that women receive the correct treatment, particularly when a pregnancy deviates from the norm and becomes high risk owing to an altered health condition.
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