Prospective study of thrombocytopenia in pregnancy

Abstract

To study the prevalence, causes, treatment and outcome of thrombocytopenia in pregnancy. Methods: 15,721 antenatal women were screened for thrombocytopenia using automated blood counter. Women with thrombocytopenia were further evaluated using history, clinical examination & investigations to diagnose the cause of thrombocytopenia. These women were treated appropriately according to the cause and followed up to know the outcome of thrombocytopenia in pregnancy. Results: Out of 15,721 patients screened, 1,212 patients had thrombocytopenia (7.7%). 949 patients found to have gestational thrombocytopenia accounting for 78.3% of all thrombocytopenic patients. Hypertension complicating pregnancy was the second major cause (15.01%). 1.60% of thrombocytopenic women had ITP. Other causes were fever complicating pregnancy (50 patients), Bone marrow disorders (2 patients), and Jaundice complicating pregnancy (9 cases). Platelet count normalized within 2 weeks of delivery without treatment in gestational thrombocytopenia patients. All the patients with ITP and Aplastic anaemia responded well to steroids. Patients with fever and liver disease complicating pregnancy were treated supportively. Platelets transfused in all patients with severe thrombocytopenia to avoid hemorrhagic complications during delivery. Maternal morbidity and mortality was high in hypertension complicating patients. Regarding perinatal outcome only 2 neonates of ITP mothers had platelet count < 50,000/cumm (one delivered by vaginal and other by LSCS) but none of them developed hemorrhagic complications. Conclusion: Prevalence of thrombocytopenia in pregnancy is 7.7%. Gestational thrombocytopenia is the major cause of thrombocytopenia in pregnancy (78.9%). Platelet count > 1lakh/cumm and without past h/o thrombocytopenia should rise the doubt of Gestational thrombocytopenia. ITP should be considered in patients with past history of low platelets. Caesarean deliveries should be reserved for obstetric indications alone. For gestational thrombocytopenia normalization of platelet count after delivery is necessary.

Pregnancy emerged thrombocytopenia: maternal and fetal outcome

“…46 cases in 11,258 cases which is much higher than the prevalence of 2-3 cases per 10,000 in studies like Nisaratanaporn. 8 The mean age in our study is 23.80±3.46 years (19-35 years), a maximum case were seen between 21-24 years age group which is similar to the study by Sumathy et al 9 52.2% of primi and 47.8% of multigravida were seen in our study, comparable to 55.6% primi and 44.4% multi in the same study by Sumathy et al 9 The most common etiology found in our study is gestational thrombocytopenia (45.6%), similar results are found in study by Begum et al (49%), Vyas et al (44.6%) and Pallavi et al 4,10,11 41.3% of cases had hypertensive disorder of which 14 had HELLP syndrome and 1 had chronic hypertension, comparable to study by Begum A et al where 36.5% cases of hypertension with 2 cases of chronic hypertension and 7 cases of HELLP were seen. 4 7 cases (15.3%) of AFLP are seen in our study similar to that by Zahida Parveen et al (n=7, 35%).…”

“…13 4 patients had DIC (8.6%) and 1 patient had ARDS in our study whereas 4 cases of DIC and 1 case of ARDS are showed by Sumathy et al and 13.6% cases of DIC showed by Sibai et al 9,14 5 cases (2.7%) of placental abruption and 9.4% cases of abruption was reported by Sumathy et al and Pallavi et al respectively, but no cases of abruption were seen in our study. 9,11 None of our patients had hemoperitoneum similar to study by Arora et al 12 According to the British committee for standards in hematology the mode of delivery in women with thrombocytopenia should be decided primarily by obstetrical indications. There is no evidence to support the routine use of caesarean section.…”

“…Sumathy et al study reported 10 patients of dengue, 5 patients of typhoid, 2 cases of intrauterine sepsis and 13 patients of malaria. 9 Only one case of ITP is found in our study who went against medical advice, follow up was not available.…”

“…6 cases of caesarean section wound gape where one underwent exploratory laparotomy is seen in our study. 9,11,12 The study by Pallavi et al showed 1% cases and that of Sumathy et al shows that 0.5% case of incisional site oozing. 9,11 1 case of vaginal hematoma (2.17%) is seen which is similar to study by Pallavi et al having 1 case (2.5%) of episiotomy hematoma and Arora et al reported 5 (3.6%) cases of wound hematoma.…”

“…There is no evidence to support the routine use of caesarean section. 9 had caesarean section done for obstetrical indications only, and none underwent instrumental delivery in our study. 61.54% (n=80) had vaginal delivery and 36.26% (n=47) had caesarean section and 2.2% (n=3) had instrumental delivery in the study by Pallavi et al 11 7 patients were undelivered in our study of which 1 expired due to hepatic encephalopathy before delivering, 4 cases of gestational thrombocytopenia were discharged and had regular follow up, one patient each of ITP and GT went against medical advice and missed their follow ups too.…”