Risk factors of thrombocytopenia in pregnancy

Ayisha Begam; Sujatha TL; Bindu Nambisan; Vasanthakumari KP

doi:10.18203/2320-1770.ijrcog20170408

Authors

Ayisha Begam Department of Obstetrics and Gynecology, Government Medical College, Trivandrum, Kerala, India
Sujatha TL Department of Obstetrics and Gynecology, Government Medical College, Trivandrum, Kerala, India
Bindu Nambisan Department of Obstetrics and Gynecology, Government Medical College, Trivandrum, Kerala, India
Vasanthakumari KP Department of Obstetrics and Gynecology, Government Medical College, Trivandrum, Kerala, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20170408

Keywords:

Gestational thrombocytopenia, ITP, Preeclampsia

Abstract

Background: Thrombocytopenia in pregnancy occurs due to several etiologies which include both pregnancy specific and non pregnancy related causes. It is second only to anemia as the most common hematological abnormality encountered in pregnancy. Better antenatal care has led to increased detection. Once diagnosed, it is important to further evaluate and to determine the cause to optimize management. Several studies have been undertaken across the world; however there are very few studies in Kerala hence this study. The aim of this study was to determine the risk factors of thrombocytopenia in pregnancy.

Methods: This was a case control study undertaken in the Department of Obstetrics and Gynecology, Medical college Hospital, Trivandrum, Kerala. Using purposive sampling, a sample size of 96 cases and 96 controls were included in this study. “Cases” were antenatal women with thrombocytopenia and “controls” were consecutive women without it. Study period was 18 months and analysis was done using SPSS version 22.

Results: In 49% of subjects ,the cause was identified as gestational thrombocytopenia,39.5% cases were due to hypertensive disorders of pregnancy.10.4% was due to ITP. SLE, AFLP, Dengue infection, HUS and APLA were rare causes of thrombocytopenia in our hospital. Of the 96 cases enrolled in the study,88 were diagnosed during pregnancy. Amongst the hypertensive disorders,16.7% was due to gestational hypertension,10.4% due to preeclampsia and 7.4% were due to HELLP syndrome.82.3% of patients with thrombocytopenia in this study were asymptomatic.

Conclusions: Thrombocytopenia should be evaluated by making a practice of routinely checking the platelet count and peripheral smear in early pregnancy and also in third trimester to enable early diagnosis since most cases may be asymptomatic.

Metrics

Metrics Loading ...

References

McCrae KR. Thrombocytopenia in Pregnancy. In: Michelson AD, ed. Platelets. New York, NY: Elsevier; 2006:925-933.

Boehlen F, Hohlfeld H, Extermann P, Perneger TV, de Moerloose P. Platelet count at term pregnancy: a reappraisal of the threshold. Obstet Gynecol. 2000;95:29-33

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

Shehata N, Burrows RF, Kelton JG. Gestational thrombocytopenia. Clin Obstet Gynecol. 1999;42:327-34.

Magann EF, Martin JN Jr. Twelve steps to optimal management of HELLP syndrome. Clin Obstet Gynecol. 1999;42(3):532-50.

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

BockenstedtP.et al.Thrombocytopenia in Pregnancy. Hematology/Oncology Clinics of North America. 2011;25(2);293-310.

Jeffrey A, Levy CPT, MC, FS, and Lance D. Murphy, MD, Thrombocytopenia in pregnancy. Clinical review JABFP. 2002;15(4):290-7.

Lefkou E. Bleeding disorders in pregnancy. Obstetrics, Gynecology and Reproductive Medicine. 2008;18(8):217-23.

Bermas BL, Smith NA, Pisetsky DS, Curtis MR. Pregnancy in women with systemic lupus erythematosus.uptodate.com.

Adams TM, Allaf MB, Vintzileos AM. Maternal thrombocytopenia in pregnancy. Clinics in Laboratory Medicine. 2013;33(2):327-41.

Arvieux J, Hachulla, E. Le syndrome des antiphospholipides. Annales de Cardiologieetd' Angéiologie. 2002;5(3):146-51.

Parnas M, Sheiner E, Shoham-Vardi I, Burstein E, Yermiahu T, Levi I, et al. Moderate to severe thrombocytopenia during pregnancy Eur J Obstet Gynecol Reprod Biol. 2006;128(1-2):163-8.

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).

Mamatha S. Thrombocytopenia during pregnancy. Journal of Evolution of Medical and Dental Science. 2010;3(57):12956-60.

Salnlo. Maternal thrombocytopenia at term: a population-based study. Acta Obstetriciaet Gynecologica Scandinavica. 2000;79(9).

Katke RD. Thrombocytopenia during pregnancy: an institutional based study. Int J Reprod Contracept Obstet Gynecol. 2014;3(4):947-51.

Nisha. Prevalence and Characterization of Thrombocytopenia in Pregnancy in Indian Women. Indian J of hematology and blood transfusion. 2012;28(2):77-81.

Asmaa M. Thrombocytopenia in Iraqi Pregnant Women. J Fac Med Baghdad. 2011;53(2).