DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20204228

Pregnancy emerged thrombocytopenia: maternal and fetal outcome

Fasiha Tasneem, Vinutha M. Sharma

Abstract


Background: A low platelet count is often an incidental finding in pregnancy. It can be an indicator of a severe systemic disorder requiring emergent maternal and fetal care or can just be unique to pregnancy with no harm to mother or fetus. Physiological decrease in platelet count is seen in pregnancy due to hemodilution and hypercoagulating state, though the exact pathophysiology is still unclear.

Methods: It is a prospective observational study done in a tertiary care centre.

Results: In about 11,258 cases screened 46 patients had thrombocytopenia (0.4%). The commonest etiology is found to be gestational thrombocytopenia (n=21, 45.6%) followed by preeclampsia/ eclampsia/ HELLP (haemolysis, elevated liver enzymes, low platelet count) syndrome (n=19, 41.3%). Only one patient had immune thrombocytopenic purpura (ITP) and 7 (15.3%) were associated with amplified fragment length polymorphism (AFLP). Maximum of them (n=19, 41.3%) underwent spontaneous vaginal delivery. 4 patients (8.6%) had postpartum haemorrhage, 6 (13.04%) had ceserean section wound infection, 4 (8.6%) had disseminated intravascular coagulation (DIC) and 4 (8.6%) had multiorgan failure. 13 patients (28.3%) had platelet count between 40 to 60 thousand per cumm, 11 (23.9%) had between 60 to 80 thousand per cumm, 10 (21.7%) had between 80,000 to 1 lakh and none had their platelet count less than 20,000 per cumm.

Conclusions: Gestational thrombocytopenia is not a preventable condition. It is an incidental finding in pregnancy. With strict vigilance during intrapartum and postpartum period, even without any treatment proper for the same, the maternal and fetal outcome is found to be good.


Keywords


DIC, HELLP, Multiorgan failure

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References


Sullivan CA, Martin JN Jr. Management of the obstetric patients with thrombocytopenia. Clin Obstet Gynecol 1995; 38: 521-34.

Levy JA, Murphy LD. Thrombocytopenia in pregnancy. J Am Board Fam Pract.2002 Jul-Aug; 15(4):290-7.

Burrows R.F. & Kelton J.G. Thrombocytopenia at delivery: a prospective survey of 6715 deliveries. American Journal of Obstetrics and Gynaecology.1990; 162: 732-734.

Begum A, Sujatha TL, Nambisan B, Vasanthakumari KP. Risk factors of thrombocytopenia in pregnancy. Int J Reprod Contracept Obstet Gynaecol 2017; 6: 700-6.

Zahida Parveen Brohi, Uzma Perveen, Aneela Sadaf. Thrombocytopenia in pregnancy: an observational study, Pak J Med Res, vol.52, No.3, 2013.

Anca Marina Ciobanu, Simona Ciobaba, Brandusa Cimpoca, Gheorghe Peltecu, Anca Maria Panaitescu. Thrombocytopenia in pregnancy. A journal of clinical medicine, vol 11, no 1, 2016, 55-60.1

Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Proven D, Arnold DM, et al. A Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 2009; 113(11):2386-93.

Nisaratanaporn S, Sukcharoen. Outcome of idiopathic thrombocytopenic purpura in pregnancy in King Chulalongkorn memorial hospital. JB Med Assoc Thai 2006; 89:S70-5.

V Sumathy, C Devi, S Padmanaban. Prospective study of thrombocytopenia in pregnancy, International Journal of Clinical Obstetrics and Gynaecology, 2019;3(1):17-21.

Vyas R, Shah S, Yadav P, Patel U. Comparative study of mild versus moderate to severe thrombocytopenia in third trimester of pregnancy in a tertiary care hospital. NHL Journal of medical sciences.2014;3(1).

Pallavi Satish Vishwekar, R K Yadav, Coneel B Gohel, thrombocytopenia during pregnancy and its outcome – A Prospective study, Journal of Krishna institute of medical sciences university, vol 6, no 1, 2017.

Arora M, Goyal L, Khutan H. Prevalence of thrombocytopenia during pregnancy & its effect on pregnancy & neonatal outcome. Ann. Int. Med. Den Res. 2017; 3(2):ME04-ME06.

Audibert F, Friedman SA, Frangieh AY, Sibai BM. Clinical utility of strict diagnosis criteria for the HELLP( hemolysis, elevated liver enzymes, and low platelets syndrome). Am J Obstet Gynaecol.1996; 175: 460-464. DOI: 10.1016/S0002-9378(96)70162-X.

Sibai BM, Taslimi MM, el- Nazer et al. maternal- perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia- eclapmsia. Am J Obstet Gynaecol.1986; 155(3):501.

Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood2010; 115: 168-86.

Gernsheimer T, James AH, Stasi R - How I treat thrombocytopenia in pregnancy. Blood 2013; 121:38-47.