Effect of mild preoperative thrombocytopenia on postpartum hemorrhage after cesarean deliveries

Abstract

BACKGROUND: Thrombocytopenia at the time of delivery is considered as a risk factor for postpartum hemorrhage. However, platelet count thresholds for postpartum hemorrhage are variable and not extensively studied. OBJECTIVE: This study aimed to examine whether mild thrombocytopenia is associated with an increased risk of postpartum hemorrhage among women undergoing cesarean delivery. STUDY DESIGN: This was a retrospective cohort study of all women who underwent cesarean delivery at a tertiary care hospital labor and delivery unit from September 2015 to June 2018. Women with normal platelet counts (≥150,000/mL) were compared with women with mild thrombocytopenia (100,000−149,000/mL). Women were excluded if they had moderate to severe thrombocytopenia (platelet count of <100,000/mL) or had received a platelet transfusion. The primary outcome was postpartum hemorrhage (quantitative blood loss of ≥1000 mL). Secondary outcomes included frequencies of red blood cell transfusion, wound complications (surgical site infections, dehiscence, or hematoma), and postpartum emergency department visits. Adjusted odds ratios with 95% confidence intervals were calculated, controlling for maternal age, gestational age, body mass index, scheduled cesarean delivery, hypertension, and preoperative hemoglobin level. RESULTS: Of 3133 women, 2799 (89.3%) had normal platelet levels, 298 (9.5%) had mild thrombocytopenia, and 36 (1.2%) had moderate to severe thrombocytopenia. There were no differences in the risks of postpartum hemorrhage, need for a red blood cell transfusion, wound complications, or postpartum emergency department visit comparing women with normal platelet counts with those with mild thrombocytopenia (24.6% vs 25.8% [adjusted odds ratio, 1.16; 95% confidence interval, 0.88−1.54]; 6.5% vs 6.7% [adjusted odds ratio, 1.34; 95% confidence interval, 0.80−2.24]; 4.5% vs 5.4% [adjusted odds ratio, 1.53; 95% confidence interval, 0.88−2.64]; 9.0% vs 10.7% [adjusted odds ratio, 1.37; 95% confidence interval, 0.92−2.03], respectively). CONCLUSION: Preoperative mild thrombocytopenia was not associated with postpartum hemorrhage, red blood cell transfusion, wound complications, or postpartum emergency department visits in women undergoing cesarean delivery.

Assessment of post‐partum haemorrhage risk among women with moderate thrombocytopenia

“…Caesarean section has always been considered a major risk factor for PPH; however, in our cohort of thrombocytopenic patients we did not find a difference between vaginal delivery and caesarean section or an increased risk of PPH associated with the surgical delivery. The same conclusion was recently reported by DiSciullo et al 24 , who did not find an increased risk of PPH when comparing controls to mild thrombocytopenic women undergoing caesarean delivery.…”

Hemostatic biomarkers associated with postpartum hemorrhage: a systematic review and meta-analysis

“…The 2 researchers read then the remaining 117 full-text articles and excluded 36 more articles, which led to the final inclusion of 81 articles in the qualitative synthesis. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , ...…”

The Impact of Prepartum Platelet Count on Postpartum Blood Loss and Its Association with Coagulation Factor XIII Activity

“…Previous studies have analyzed the association of platelet counts with postpartum blood loss as well, but the blood loss was merely estimated and arbitrarily set thresholds were used (e.g., 500 mL, 1,000 mL, etc., for blood loss and 100 G/L, 150 G/L, etc., for platelet counts). As categorization is prone to a loss of information, this might have led to the contradictory results reported by these studies [2][3][4][5][6][7][8]. In contrast, we performed a continuous outcome logistic regression analysis involving blood coagulation factors I, II, and XIII and analyzed the effect of prepartum platelet counts on postpartum blood loss over the whole spectrum of MBL volumes.…”

“…On the contrary, some other studies did not reveal any correlation of platelet count with an increased risk for postpartum hemorrhage [6][7][8]. However, some of these mentioned studies might have been underpowered by including fewer than 200 parturients [6,7].…”