ROLE OF CORTICOSTEROIDS IN TREATMENT OF LOW-PLATELET DISEASES IN PREGNANT WOMEN

Main Article Content

Dr Shirin Adnan Yousef
Dr Amal Hazzouri
Dr Ashraf Olab

Keywords

Thrombocytopenia, Pregnancy, Dexamethasone

Abstract

Background and Objectives : Assessment of pregnant women associated with thrombocytopenia( incidence – proposed risk factors – different causes of thrombocytopenia – maternal and neonatal complications) as it is an important disorder and considered a second haematological disorder during pregnancy after iron-deficiency anaemia . It is defined as  aplatelet count below < 150,000/mm3 .This study compared two groups of participants to prove that dexamethasone is  relatively safe and cost-effective in elevating of platelet count in Hellp syndrome.


Methods : This was a statistical descriptive study ,also  experimental randomized controlled trial to  investigate the role of  dexamethasone in treatment , was conducted in the hospital of Obstetrics and Gynecology,Aleppo,Syria over 2 years.the participants were 600 women with thrombocytopenia, 210 of them who underwent dexamethasone and observation ,  platelet count was reassessed after 12-24-48 hours via CBC.


Results : incidence was 7.31%, different causes were: Gestational 58% - Hypertension-related diseases 23.5% -  Idiopathic Thrombocytopenia Purpura 2,8% -  Drugs 2.5% - Viral 2.2% - Bone Marrow Diseases 1.2% - Acute fatty Liver Of Pregnancy 0.5% - Heamolytic Ureamic Syndrome 0.3% - Antiphospholipid Antibodies Syndrome 0.3% - Systemic Lupus Syndrome 0.2%, Severity was: Mild 83.5% - Moderate 14.3% - Severe 2.2%,presence of risk factors: Hypertension 23.5% - Diabetes Mellitus 1.8% - Smoking 11.2% - Age 20-24 yrs 25.3% .Maternal Complications were: Blood 24.5%,Plasma 14.7%,Platelet 4% Transfusion – Labour Induction 1% - Placental Abruption 3.2% - Placental Previa 5.7% - Purpura 1.3% - Ecchymosis 2.2% - Vaginal Bleeding 17% - Drainage Bleeding 19.8% - Haematuria 1.2% - Dissaminated Intravascular Coagulation 1.3%. Fetal and Neonatal Complications: Apgar Scores at 1-5 minute less than 7 was  7.2%,2.2% , preterm Delivery 22.3% , Premature Rupture Of Membrane 2.2% , Neonatal Death 0.5% .It showed beneficial of  dexamethasone in elevating platelet count  accordin to cause of thrombocytopenia as it was  safe and cost –effective in HELLP Syndrome  and it did not benefit in bone  marrow diseases.

Abstract 172 | pdf Downloads 81

References

1. Sir.Sabaratnam Arulkumaran, PhD,Alexandra Rees and AMY Schacaluga .MRCOG , part2 , Royal College of Obstetricians and Gynecology,Obstetric Medicine, Obstetric Maternal Medicine. Cambridge University ,1stEdition ,Britain 2017 ., 270 p.
2. Keith R , MC.Crae .American Society Of Hematology, Low platelet Diseases. Cleveland Clinic Foundation ,16th Edition 2012 ., 210 p.
3. Gray Cf , Kenneth Jt , Steven Lb , John Ch , Larry Gi , Katharine Dw .Williams Obstetrics,Hematological Diseases-Thrombotic Microangiopathies . University of Taxas, 23rd Edition , Southwestern Medical Center 2010., 1150 p.
4. Gray CF, Kenneth JT, Steven LB, John CH, Larry G, Katharine DW.Williams Obstetrics, Hematological Diseases-Thrombotic Microangiopathies. University of Taxas,25th Edition, Southwestern Medical Center 2018., 1330 pages.
5. Gibbs Ji, Ronald Su, Karlan Asi, Beth Y, Haney Sue, Arthur F, Nygaard, Ingrid E.Danforth's Obstetrics And Gynecology, Thrombotic Microangiopathies ,Wolters Kluwer,South Asian,10th Edition 2008 . , 586.
6. Noris Pu, Schlegel Nui, Klersy Cri.Analysis of 339 pregnancies, Haematological, Thrombocytopenia and platelet Function Disorders, EHASWG 2014 ., 8(99), 87-94.
7. Billett Hn J.AssocAcad Minor Phys .Thrombocytopenia in pregnancy,Immune disorders and Essential Thrombocytopenia ASH 1994., 3(120):99-117.
8. Crowther MA, Burrow R.F,Kelto J.G.Thrombocytopenia in pregnancy, diagnosis, pathogenes is and management, blood review ASH 1996 ., 1(10) ,8-9.
9. Fernando Asus.Causes of thrombocytopenia in pregnancy.Uropean JOGRB 2007., 3(5),3-4.
10. Wang Da-peng , Liange Mei-ying, Wang Shan-mi.Clinical Analysis of Pregnancy Complicated with Thrombocytopenia . Pubmed ,Departement of Obstetrics,Peking University People's Hospital ,Beijing,China IJWH 2010 .,45(6):401-5.
11. Michal Parnas, Eyal Sheiner , Liana shoham-Varid .Moderate to Severe thrombocytopenia during pregnancy. Pubmed ,Faculty of Health Science,Sorok University Medical Center,Ben Gurion University of the Negev,Be'er-Sheva,Palestine BMC Women'sHealth 2006 .,128(1-2):163-8.
12. Copplestone J A .Thrombocytopenia developing during pregnancy. Pubmed, Derriford Hospital , Plymouth , Devon ,Britain MED QOGJ 1992 .,84(304):593-601.
13. Tikva Yermiahu, Ronit Yerushalmi.Causes of thrombocytopenia in pregnancy, EHASWG 2007 .,10(10):16.12.031.
14. Yalcin Ot, Sener Tu, Hassan Hui, Ozalp Su, Okur Ai. Effect of postpartum corticosteroids in patients with HELLP syndrome, Int J Gyn& Obs 1998.,6(61):141-148.
15. Dreyfus Mai, Tissier Icu , Ndocko Ma, Denoual Ia, Baldauf J.J ,Ritter Ju.Corticosteroid therapy for conservative management in marginally-viable pregnancy complicated by HELLP syndrome . Eur Obs& Gyn RB 1999 .,1(85):233-234.
16. Alenezy Sarah,ALBarrak Majd,ALOtaibi Nouf. Study Designs,INTRODUCTION TO STUDY DESIGNS, KSU college Medicine 2019-2020.,9(1-4).
17. Prof.Fernando Figuerira. Obstetric cases of Thrombocytopenia and Treatment.Intensive Care Unit , BioMed Central, Instituto de Medicina Integral ,Recife ,PE ,Brazil BMC PC 2013 .,1(10.1186) :1742-4755-10-2.
18. Evistavrou Md ,KEITH R.McCare Md.Immune Thrombocytopenia in pregnancy.Hema-Onco CNA 2009 ., 23(6)299-316.
19. Leila Katz, Melania Amorim, JOSE G Cecatti ,FERNANDO Figueira.CoHELLP :Collaborative randomized controlled trial on corticosteroids in HELLP syndrome. Pubmed,Reprod Health, Obstetric Intensive Care Unit, Instituto de Medicina Integral, Brazil MEFSJ 2013 .,10(11):86/1742-4755-10-28.
20. Dougalas M Woudstra, Sue Chandra, Therese Dowswell. Corticosteroid for HELLP(hemolysis,elevated liver enzymes,low platelets)syndrome in pregnancy. Pubmed, Department of obstetrics and Gynecology,University of Alberta Hospital , Canada RCOYG , 2010.,10(1002):14651858-148 .
21. Minhong Mao, Chen Chen.Corticosteroid Therapy for Management Of Thrombocytopenia and Elevated Liver Enzymes, Meta-Analysis. Pubmed ,Weat Zone,Beijing Chaoyang Hospital ,Capital Medical University, Beijing, China TJOG 2015 ., 10(126):59/895220 .
22. Akimasa Takahashia ,Yuji Tanaka,Tetsuo One, Takashi Murakami. Effects of high-dose dexamethasone in postpartum women with thrombocytopenia. Pubmed ,Department of Obstetrics and Gynecology,Shiga University Of Medical Science , Japan TJOG 2019 ., 10(1080)01443615:2018.339 .
23. Rune Svenningsen, NILS-Halvdan Mrken, Jarl A Kahn. Corticosteroids in the treatment of thrombocytopenia in pregnancy and HELLP-syndrome. Pubmed, Tidsskr Norlaegeforen Hospital , Norwaj JSAFOG 2006 .,126(17):2253-6.
24. Naima Khrouf, Cherif. Antenatal corticotherapy of thrombocytopenia. Pubmed, Mourad Bouchank Hospital, Service de maternite et de neonatologie,Tunis CEOGJ 2005.,84(4):10.1002/14651
25. Arab Health Ministry Council , Arab Doctor Union , World Health Organisation , Arab Education and Science Organisation . Union Medical Dictionary , third Edition , Medlifent , Switzerland 1983 .,2196 pages, 561-597.
26. Dahman Ahmad . Art of Obstetrics . University Book and Publication Department , Damascus , Syria 2008., 980 pages, 570-631.
27. Kabos Amal ,Darkazanli Mohamd Samir ,Balksh Abdlmajid .Principal Of Statistics. First Edition, University Book and Publication Department ,Aleppo University , Syria 2005.,395 p.