OBJECTIVE: To assess whether mild thrombocytopenia (platelet count 100–149 k/microliter) is associated with an increased risk of postpartum hemorrhage. METHODS: Nulliparous women with term, singleton, vertex pregnancies undergoing labor at our institution between August 2016 and September 2017 were included. The primary exposure was mild thrombocytopenia, defined as platelet count 100–149 k/microliter, and the comparator was normal platelet count (150 k/microliter or greater). Those with severe thrombocytopenia (platelet count less than 100 k/microliter) were excluded from analysis. The primary outcome was postpartum hemorrhage, determined by International Classification of Diseases, Tenth Revision codes and the hospital discharge problem list. Secondary outcomes included use of uterotonic agents (methylergonovine maleate or carboprost tromethamine), total blood loss 1,000 mL or greater, and blood transfusion. Data were analyzed by t test, χ2 or Fisher exact test, and multivariable logistic regression, with significance at α <0.05. RESULTS: We evaluated 2,845 eligible women, of whom 2,579 (90.2%) had normal platelet count 150 k/microliter or greater, 266 (9.3%) had platelet count 100–149 k/microliter (mild thrombocytopenia), and 13 (0.5%) had platelet count less than 100 k/microliter (severe thrombocytopenia). Compared with women with normal platelet count, those with mild thrombocytopenia had a higher rate of postpartum hemorrhage (16.9% vs 8.5%, P<.001) and were more likely to have total blood loss 1,000 mL or greater (4.5% vs 1.7%, P=.002) and receive methylergonovine maleate (10.5% vs 5.9%, P=.003) or carboprost tromethamine (6.0% vs 1.6%, P<.001) or both (3.8% vs 1.0%, P<.001), but rates of blood transfusion were no different (1.9% vs 1.5%, P=.59). The association between mild thrombocytopenia and postpartum hemorrhage persisted after multivariable adjustment for potential confounders (adjusted odds ratio 2.2, 95% CI 1.5–3.2, P<.001). CONCLUSION: Among nulliparous women with term, singleton, vertex pregnancies undergoing labor, those with mild thrombocytopenia (platelet count 100–149 k/microliter) had a twofold greater likelihood of postpartum hemorrhage compared with those with normal platelet count.

Pregnancy-associated atypical hemolytic uremic syndrome (aHUS) is a life-threatening thrombotic microangiopathy which may be mistaken for hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. We sought to identify laboratory parameters that differentiate aHUS and HELLP syndrome in the postpartum period. PubMed was searched from inception to March 2018 to identify cases of aHUS in the postpartum period, while cases of HELLP syndrome were identified from a cohort of deliveries at our institution from January 2015 to December 2018. Postpartum laboratory data were abstracted as either peak values (AST [aspartate transaminase]; creatinine; LDH [lactate dehydrogenase]) or nadir values (hemoglobin; platelet count). Differences were compared using the t test, Wilcoxon Rank Sum, or χ 2 test, and receiver operating characteristic (ROC) curve analyses were performed. We identified 46 cases of aHUS and 45 cases of HELLP syndrome in the postpartum period. Women with HELLP syndrome were older, but rates of nulliparity and cesarean delivery, and gestational age at delivery, were similar between groups. Peak serum creatinine and LDH values after delivery were the most useful to diagnose aHUS with area under the curve 0.996 (95% CI, 0.99–1.0) and 0.91 (95% CI, 0.83–0.98) respectively. Serum creatinine ≥1.9 mg/dL, LDH ≥1832 U/L, or serum creatinine ≥1.9 mg/dL in combination with LDH ≥600 U/L were the optimal thresholds for diagnosing pregnancy-associated aHUS. We conclude that standard laboratory data, most specifically peak serum creatinine and LDH, may be used to differentiate aHUS and HELLP syndrome in the postpartum period.

CONCLUSIONS: TP53 (rs1625895) C>T polymorphism was associated with ovarian reserve and apparently affected ovarian response to rFSH and the clinical outcomes of IVF/ICSI cycles. Homozygosity of the T allele was associated with significantly poorer results. The identified SNP might provide an additional tool to test patients for ovarian reserve/response and thus help in the individualization of ovarian stimulation protocols. To the best of our knowledge, this was the first study to associate this SNP and ovarian response to gonadotropins.SUPPORT: Merck Grant for Fertility Innovation (GFI-2014).

albumin was detectable in CSF, but the CSF/plasma albumin quotient did not increase in preeclampsia (p¼0.78, vs. controls). Moreover, CSF albumin levels were not increased in the subset of 8 preeclampsia subjects with severe features [median 16.0 mg/dl, interquartile range (12.5-17.0)]. CONCLUSION: We find that the integrity of the blood-brain-barrier is maintained in preeclampsia despite evidence of systemic inflammation and terminal complement activation.