Etiological review and outcome of thrombocytopenia in pregnancy in the tertiary care centre

Authors

  • Sangeeta S. Desai Department of Obstetrics and Gynecology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Kolhapur, Maharashtra, India
  • Kavita S. Kabade Department of Obstetrics and Gynecology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Kolhapur, Maharashtra, India
  • Sumitra Reddy T. S. K. Department of Obstetrics and Gynecology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Kolhapur, Maharashtra, India
  • Gheya Devireddy Department of Obstetrics and Gynecology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Kolhapur, Maharashtra, India https://orcid.org/0000-0002-5479-3056

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20231054

Keywords:

Thrombocytopenia in pregnancy, Etiology of thrombocytopenia in pregnancy, Maternal mortality associated with thrombocytopenia, Outcome of Thrombocytopenia in Pregnancy

Abstract

Background: Objective of the study was to identify and analyse the etiology of thrombocytopenia in pregnancy and review the evaluation of thrombocytopenia and its outcome in pregnancy.

Methods: Retrospective study conducted at D. Y. Patil Hospital, Kolhapur, Maharashtra, India, from January 2021 to January 2023, in the Department of Obstetrics and Gynecology. All the antenatal women admitted in the ward of obstetrics and gynecology with platelet count less than 1 lakh/cubic cc were included in the study. Thorough evaluation for the cause of thrombocytopenia and outcome of the patient were collected and results were analyzed.

Results: Out of 3319 deliveries, 100 patients had platelet counts less than 1 lakh. Overall, in the present study, Gestational thrombocytopenia (38%) is the most common cause of low platelets in pregnancy, followed by pre-eclampsia (20%) and DIC (16%). The rest of the etiologies rarely cause thrombocytopenia in pregnancy (<10%).

Conclusions: Despite thrombocytopenia is a common abnormality in pregnancy, it seldom leads to life-threatening complications by itself. By contrast, a significant thrombocytopenia associated with medical conditions can have serious maternal-fetal consequences and requires appropriate management. The management of thrombocytopenia focuses on the underlying cause/etiology which is challenging because there are many potential causes, some directly related to the pregnancy and some unrelated. Cause directed therapies, if promptly administered, may significantly improve the maternal and fetal outcomes. Study intended to evaluate the wide spectrum of causes for thrombocytopenia in pregnancy and its outcome. Preeclampsia with or without HELLP syndrome is found to be very important cause of severe thrombocytopenia and attributed with maternal complications. while the perinatal outcome of gestational thrombocytopenia and immune thrombocytopenic purpura is basically favourable.

References

Perepu U, Rosenstein L. Maternal thrombocytopenia in pregnancy. Proceed Obstet Gynecol. 2013;3:6.

Gernsheimer T, James AH, Stasi R. How I treat thrombocytopenia in pregnancy. Blood. 2013;121(1):38-47.

Stasi R. How to approach thrombocytopenia. Hematology Am Soc Hematol Educ Program. 2012;191-7.

Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, et al. 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.

Cines DB, Levine LD. Thrombocytopenia in pregnancy. Blood. 2017;130(21):2271-7.

Myers B. Diagnosis and management of maternal thrombocytopenia in pregnancy. Br J Haematol. 2012;158(1):3-15.

Provan D, Stasi R, Newland AC. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010;115:168-86.

D'Andrea G, Chetta M, Margaglione M. Inherited platelet disorders: thrombocytopenias and thrombocytopathies. Blood Transfus. 2009;7(4):278-92.

Chaudhary RK, Nepal C, Khanal N, Pathak R, Giri S, Bhatt VR. Management and Outcome of Heparin-Induced Thrombocytopenia in Pregnancy: A Systematic Review. Cardiovasc Hematol Agents Med Chem. 2015;13(2):92-7.

Fogerty AE. Thrombocytopenia in Pregnancy: Mechanisms and Management. Transfusion Med Rev. 2018;32(4):225-9.

Devos T, Meers S, Boeckx N, Gothot A, Deeren D, Chatelain B, et al. Diagnosis and management of PNH: Review and recommendations from a Belgian expert panel. Eur J Haematol. 2018;101(6):737-49.

Warkentin TE, Greinacher A. Management of heparin-induced thrombocytopenia. Curr Opinion Hematol. 2016;23(5):462-75.

Habas E, Rayani A, Ganterie R. Thrombocytopenia in hypertensive disease of pregnancy. J Obstet Gynaecol India. 2013;63(2):96-100.

Wang X, Xu Y, Luo W, Feng H, Luo Y, Wang Y, et al. Thrombocytopenia in pregnancy with different diagnoses: differential clinical features, treatments, and outcomes. Medicine (Baltimore). 2017;96(29):e7561.

Sainio S, Kekomäki R, Riikonen S, Teramo K. Maternal thrombocytopenia at term: a population-based study. Acta Obstet Gynecol Scand. 2000;79(9):744-9.

Elveđi-Gašparović V, Beljan P, Gverić-Ahmetašević S, Schuster S, Škrablin S. Fetal-maternal complications and their association with gestational thrombocytopenia. Ginekologia Polska. 2016;87(6):454-559.

Ying-Hsuan L, Liang-Ming L, Ching-Chang H. Perinatal outcome in normal pregnant women with incidental thrombocytopenia at delivery. Taiwan J Obstet Gynecol. 2013;52:347-50.

Dwivedi P, Puri M. Nigam A. Fetomaternal outcome in pregnancy with severe thrombocytopenia. Eur Rev Med Pharmacol Sci. 2012;16:1563-66.

Chauhan V, Gupta A, Mahajan N, Vij A, Kumar R, Chadda A. Maternal and fetal outcome among pregnant women presenting with thrombocytopenia. Int J Reprod Contracept Obstet Gynecol. 2016;5:2736-43.

Downloads

Published

2023-04-15

Issue

Section

Original Research Articles