PREVALENCE AND FACTORS ASSOCIATED WITH THROMBOCYTOPENIA IN PREGNANCY AND ITS FETOMATERNAL OUTCOME IN A TERTIARY CARE CENTRE AT SOUTH INDIA
Main Article Content
Keywords
Gestational thrombocytopenia, maternal complications, maternal outcome, fetal outcome
Abstract
Background: Thrombocytopenia (TCP), characterized by low platelet counts, is a haematological abnormality that occurs in approximately 5-10% of pregnancies, posing potential risks for fetomaternal outcomes. It stands as the most frequent hematological abnormality after anemia. Studies have indicated that while many instances of thrombocytopenia are mild and resolve after delivery, significant cases can lead to severe complications such as maternal hemorrhage, preterm birth, and adverse neonatal outcomesDiagnosing TCP in pregnancy is a significant concern for gynecologists due to the potential for bleeding complications during delivery. Therefore, identifying the cause of TCP is crucial, especially in antenatal patients.
Aims and Objective: The study aims to estimate the prevalence of TCP besides studying the fetomaternal outcome in antenatal women attending OPD.
Materials and methods: This prospective study enrolled 641 pregnant women and monitored them until discharge after delivery. Women with pre-existing medical conditions such as chronic liver disease, renal disorders, cardiac diseases, or malignancies were excluded from the study. During their initial antenatal visit, all participants underwent standard hematological tests, including platelet count measurements, performed using an automated blood count analyzer. Women with platelet counts below 150,000/µL were identified and closely followed up. Additionally, those with normal platelet counts before 28 weeks of gestation had a repeat test in the third trimester to screen for gestational thrombocytopenia. All cases of thrombocytopenia were tracked throughout the antenatal period and up to 48 hours postpartum to assess outcomes.
Results: This prospective study consists of 641 antenatal mothers and the prevalence of TCP was 6.6%. The most common contribution was by gestational TCP, accounting for 71.4% of cases. 16.7% were due to obstetric causes, and medical causes for 12% of the cases. The incidence of still births in the TCP cases was 4.8%. NICU admission rate was 19.0%.
Conclusions: Gestational TCP is the most common etiology of TCP in pregnancy and is not typically associated with any adverse outcome both for the mother or the baby. Hypertensive disorders constitute the second common etiology. ITP, SLE and APLA syndrome are rare causes of TCP in pregnancy. Although there is no risk of hemorrhagic complications in gestational thrombocytopenia as such, TCP caused by HELLP, ITP and APLA expose the mother and fetus to potentially fatal consequences which need supervision. Proper evaluation and appropriate management by both the obstetrician and hematologist place a significant role in preventing these complications.
References
2. Hooli SV, Shah N, Shah P, Suresh S, Sunil BS. Aetiology and Outcomes of Thrombocytopenia in Pregnancy: A Cross-Sectional Study in a University Hospital, India. EMJ [Internet]. 2022 Dec 5 [cited 2023 May 29]; Available from: https://www.emjreviews.com/reproductive-health/article/aetiology-and-outcomes-of-thrombocytopenia-in-pregnancy-a-cross-sectional-study-in-a-university-hospital-India.
3. Perepu U, Rosenstein L. Maternal thrombocytopenia in pregnancy.
4. Barsode S, Taralekar V, Shora M, Mehendale S. Clinical profile of thrombocytopenia in pregnancy. Indian Journal of Obstetrics and Gynecology Research. 2020 Jun 28;6:192–5.
5. Wang X, Xu Y, Luo W, Feng H, Luo Y, Wang Y, et al. Thrombocytopenia in pregnancy with different diagnoses. Medicine (Baltimore). 2017 Jul 21;96(29):e7561.
6. Paidas MJ, Haut MJ, Lockwood CJ. Platelet disorders in pregnancy: implications for mother and fetus. Mt Sinai J Med. 1994 Oct;61(5):389–403.
7. Mangla A, Hamad H. Thrombocytopenia in Pregnancy. In: Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2023 [cited 2023 May 29]. Available from: http://www.ncbi.nlm .nih.gov/books/NBK547705/
8. Thrombocytopenia in Pregnancy | Hematology, ASH Education Program | American Society of Hematology [Internet]. [cited 2023 May 29]. Available from: https://ashpublications.org/ hematology/article/2010/1/397/96387/Thrombocytopenia-in-Pregnancy
9. Janes SL. Thrombocytopenia in pregnancy. Postgrad Med J. 1992 May;68(799):321–6.
10. Nisha S., Dhakad A., Uma S., Tripathi A., & Sankhwar P.. Prevalence and Characterization of thrombocytopenia in pregnancy in Indian women. Indian Journal of Haematology and Blood Transfusion 2011;28(2):77-81. https://doi.org/10.1007/s12288-011-0107-x
11. Qurban S., Arshad S., Hussain S., Imran S., Munawar A., & Ashraf M. Frequency of thrombocytopenia in pregnant females. PJMHS 2022;16(7):997-999. https://doi.org/10.53350/pjmhs22167997
12. Myers B. Diagnosis and management of maternal thrombocytopenia in pregnancy. British Journal of Haematology 2012;158(1):3-15. https://doi.org/10.1111/j.1365-2141.2012.09135.x
13. Gebreweld A., Bekele D., & Tsegaye A. Hematological profile of pregnant women at St. paul’s hospital millennium medical college, Addis Ababa, Ethiopia. BMC Hematology 2018;18(1). https://doi.org/10.1186/s12878-018-0111-6
14. Ghafoor M., Sarwar F., Durrani T., Azher Z., Jabeen S., & Khan M. Pattern of thrombocytopenia in pregnancy at teaching hospital of Rahim yar khan, Pakistan. Journal of Rawalpindi Medical College 2023;26(4). https://doi.org/10.37939/jrmc.v26i4.2053
15. Kim B., Kim H., Kim J., & Lee K. Moderate to severe thrombocytopenia during pregnancy: a single institutional experience. Indian Journal of Hematology and Blood Transfusion 2017;33(4):581-585. https://doi.org/10.1007/s12288-017-0784-1
16. Palta A. and Dhiman P. Thrombocytopenia in pregnancy. Journal of Obstetrics and Gynaecology 2015;36(2):146-152. https://doi.org/10.3109/01443615.2015.1041893
17. Kashyap R., Garg A., & Pradhan M. Maternal and fetal outcomes of pregnancy in patients with immune thrombocytopenia. The Journal of Obstetrics and Gynecology of India 2020;71(2):124-130. https://doi.org/10.1007/s13224-020-01390-w
18. Kadir R. and McLintock C. Thrombocytopenia and disorders of platelet function in pregnancy. Seminars in Thrombosis and Hemostasis 2011;37(06):640-652. https://doi.org/10.1055/s-0031-1291374
19. Şahin M., Şahin E., Madendağ Y., Madendağ İ., & Açmaz G. Effect of gestational thrombocytopenia on negative fetal and maternal outcomes in low-risk pregnancies. Cumhuriyet Medical Journal 2019. https://doi.org/10.7197/cmj.vi.475431
20. Khatoon H., Ahmed R., Naz A., Mushtaq N., & Irfan A. To determine the frequency of thrombocytopenia in pre eclamptic presented at Isra university hospital. Journal of Pharmaceutical Research International 2021:242-247.
21. Ebrahim H., Kebede B., Tilahun M., Debash H., Bisetegn H., & Tesfaye M. Magnitude and associated factors of thrombocytopenia among pregnant women attending antenatal care clinics at Dessie comprehensive specialized hospital, northeast Ethiopia. Clinical and Applied Thrombosis/Hemostasis 2022;28.
22. Hanif M., Akhtar T., Ashraf S., Shahzadi A., & Rani H. Prevalence of thrombocytopenia in women during third trimester of pregnancy. PJMHS 2023;17(5):213-215. https://doi.org/10.53350/pjmhs2023175213
23. Nisha S., Dhakad A., Uma S., Tripathi A., & Sankhwar P. Prevalence and characterization of thrombocytopenia in pregnancy in Indian women. Indian Journal of Hematology and Blood Transfusion 2011;28(2):77-81.
24. Asrie F., Enawgaw B., & Getaneh Z. Prevalence of thrombocytopenia among pregnant women attending antenatal care service at Gondar university teaching hospital in 2014, northwest Ethiopia. Journal of Blood Medicine 2017; Volume 8:61-66. https://doi.org/10.2147/jbm.s136152
25. Gupta D., Chatterjee R., Nanda S., & Dutt A. Anaesthetic management of unexplained thrombocytopenia. Journal of Case Reports 2015:470-472. https://doi.org/10.17659/01 .2015.0121
26. Ye L., Zhou C., Li L., Zhang M., & Wang L. Effects of pregnancy-induced hypertension on early-onset neonatal thrombocytopenia. 2023. https://doi.org/10.22541/au.168714905.52785297/v1
27. Borhany M., Abid M., Zafar S., Zaidi U., Munzir S., & Shamsi T. Thrombocytopenia in pregnancy: identification and management at a reference center in Pakistan. Cureus 2022. https://doi.org/10.7759/cureus.23490
28. Fustolo‐Gunnink S., Vlug R., Smits‐Wintjens V., Heckman E., Pas A., Fijnvandraat K.et al. Early-onset thrombocytopenia in small-for-gestational-age neonates: a retrospective cohort study. American Journal of Perinatology 2016;33(S 01). https://doi.org/10.1055/s-0036-1592382
29. Mamatha S. Thrombocytopenia during pregnancy. Journal of Evolution of Medical and Dental Sciences 2014;4(57):12956-12960. ttps://doi.org/10.14260/jemds/2014/3719
30. Rath M., Smits‐Wintjens V., Oepkes D., Zwet E., Kamp I., Brand A.et al.. Thrombocytopenia at birth in neonates with red cell alloimmune haemolytic disease. Vox Sanguinis 2011;102(3):228-233. https://doi.org/10.1111/j.1423- 0410.2011.01539.
31. Duong C., Kidson‐Gerber G., Peters N., Listijono D., & Henry A. Trajectory of platelets in pregnancy – Do low‐risk women need an intrapartum full blood count prior to epidural? Australian and New Zealand Journal of Obstetrics and Gynaecology 2015;55(5):511-514. https://doi.org/10.1111/ajo.12362.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Athira.C
Junior Resident, Department of obstetrics and gynaecology Government TD Medical College Alappuzha
Dr Rachel Alexander
A Professor (CAP), Department of obstetrics and gynaecology Government TD Medical College Alappuzha
Dr Meera Lekshmi Nair
Associate Professor (CAP), Department of obstetrics and gynaecology Government TD Medical College Alappuzha