DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20162658

Maternal and fetal outcome among pregnant women presenting with thrombocytopenia

Vikrant Chauhan, Amit Gupta, Neelam Mahajan, Anju Vij, Rajinder Kumar, Abhinav Chadda

Abstract


Background: Thrombocytopenia complicates about 7-8% of all pregnancies. It is an under-explored condition in Indian women during pregnancy, so the study was planned to find out the prevalence and causative factors of thrombocytopenia during pregnancy and to review management strategies for the best feto-maternal outcome.

Methods: This prospective study was conducted in the department of obstetrics and gynecology at Dr. Rajendra Prasad Government Medical College Kangra at Tanda, Himachal Pradesh. 546 antenatal women were screened, 65 women who were diagnosed with thrombocytopenia, were included in the study.

Results: The incidence of maternal thrombocytopenia in our study was 8.4%. 63% of the women had mild thrombocytopenia while 35.4% and 1.5% of women were moderate and severe thrombocytopenic respectively. The mean maternal platelet count was 106907±30136.52/µL whereas the mean neonatal platelet count was 175307.7±33834.87/µL. The incidence of fetal thrombocytopenia was 3.1%. Amongst 65 thrombocytopenic women 1.5% had HELLP Syndrome, 26.3% had PIH and 68.2% had gestational thrombocytopenia. 27.7% were delivered by LSCS and 72.3% were delivered vaginally. The most common indication of LSCS was acute fetal distress with MSL (55%) followed by breech (25%), failed induction (10%), and the rest (10%) for other obstetrical indications. 30% women required induction of labor with misoprostol for various obstetrical indications. The most common indication for induction was mild pre-eclampsia (45%) followed by IUGR (25%), PROM (15%) and post-date (15%).

The mean baby weight in our study was 2.84±0.32 kg. Out of 65 neonates, 6.15% neonates required NICU admission. One neonate died at first post - op day because of respiratory distress syndrome. APGAR score <7 in 1 and 5 min were seen in 6.15% of neonates. Only 8% neonates were small for gestational age.

Conclusions: In pregnancy with thrombocytopenia, gestational thrombocytopenia is the commonest and benign condition which does not alter the obstetrical management. Still a vigil should be kept on maternal platelet count in antenatal period to prevent unfavorable outcome in serious conditions that may require specific and urgent management (HELLP syndrome, severe pre-eclampsia, TTP, HUS and acute fatty liver of pregnancy).


Keywords


Thrombocytopenia, Pregnancy induced hypertension, HELLP Syndrome

Full Text:

PDF

References


Kadir RA, McLintock C. Thrombocytopenia and disorders of platelet function in pregnancy. Semin Thromb Hemost. 2011;37:640-52.

McCarae KR. Thrombocytotenia in pregnancy. Hematology Am Soc Hematol Educ Program. 2010;397-402.

Lewis SM, Bain BJ, Bates I. Practical haematology, Elsevier 10th edi; 2006:14-5.

Shehata N, Burrow R, Kelton JG. Gestational thrombocytopenia. Clin Obst Gynaecol. 1999;42:327-34.

Burrows RF, Kelton JG. Thrombocytopenia at delivery: a prospective survey of 6715 deliveries. Am J O Obstet. Gynecol. 1990;162:731-4.

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

Mc Carae KR. Thrombocytotenia in pregnancy. Hematology Am Soc Hematol Educ Program. 2010;397-402.

Dwivedi P, Puri M, Nigam A, Agarwal K. Fetomaternal outcome in pregnancy with severe thrombocytopenia. Eur Rev Med Pharmacol Sci. 2012;16(11):1563-6.

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):8-11.

Burrows RF, Kelton JG. Thrombocytopenia at delivery: a prospective survey of 6715 deliveries. Am J Obstet Gynecol. 1990;162(3):731-4.

Singh N, Amita D, Uma S, Tripathi AK, Pushplata S. Prevalenceand characterization of thrombocytopenia in pregnancy in Indian women. Indian J Hematol Blood Transfus. 2012;28(2):77-81.

Ajibola SO, Akinbami A, Rabiu K, Adewunmi A, Dosunmu A, Adewumi A. Gestational thrombocytopaenia among pregnant women in Lagos Nigeria. Niger Med J. 2014;55(2):139-43.

Onisai M, Vladareanu AM, Delcea C, Ciorascu M, Bumbea H, Nicolescu A. Perinatal outcome for pregnancies complicated with thrombocytopenia. J Matern Fetal Neonatal Med. 2012;25(9):1622-6.

Brohi ZP, Perveen U, Sadaf A. Thrombocytopenia in pregnancy: an observational study. Pak J Med. 2013;52(3):67-70.

Lin YH, Lo LM, Hsieh CC, Chiu TH, Hsieh TT, Hung TH. Perinatal outcome in normal pregnant women with incidental thrombocytopenia at delivery. Taiwan J Obstet Gynecol. 2013;52(3):347-50.

Suri V, Aggarwal N, Saxena S, Malhotra P, Varma S. Maternal and perinatal outcome in idiopathic thrombocytopenic purpura (ITP) with pregnancy. Acta Obstet Gynecol Scand. 2006;85(12):1430-5.

Borna S, Borna H, Khazardoost S. Maternal and neonatal outcomes in pregnant women with immune thrombocytopenic purpura. Arch Iran Med. 2006;9(2):115-8.

Turgut A, Demirci O, Demirci E, Uludoğan M. Comparison of maternal and neonatal outcomes in women with HELLP syndrome and women with severe preeclampsia without HELLP syndrome. J Prenat Med. 2010;4(3):51-8.

Jaleel A, Baseer A. Thrombocytopenia in preeclampsia: an earlier detector of HELLP syndrome. J Pak Med Assoc. 1997;47(9):230-2.

Ruggeri M, Schiavotto C, Castaman G, Tosetto A, Rodeghiero F. Gestational thrombocytopenia: a prospective study. Haematologica. 1997;82(3):341-2.

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.

Nazli R, Khan MA, Aakhtar T, Mohammad NS, Aslam H, Haider J. Frequency of thrombocytopenia in pregnancy related hypertensive disorders in patients presenting at tertiary care hospitals of Peshawar. KMUJ. 2012;4(3):101-5.

Bhat YR, Cherian CS. Neonatal thrombocytopenia associated with maternal pregnancy induced hypertension. Indian J Pediatr. 2008;75(6):571-3.

Won YW, Moon W, Yun YS, Oh HS, Choi JH, Lee YY, et al. Clinical aspects of pregnancy and delivery in patients with chronic idiopathic thrombocytopenic purpura. Korean J Intern Med. 2005;20(2):129-34.

Kasai J, Aoki S, Kamiya N, Hasegawa Y, Kurasawa K, Takahashi T, et al. Clinical features of gestational thrombocytopenia difficult to differentiate from immune thrombocytopenia diagnosed during pregnancy. J Obstet Gynaecol Res. 2015;41(1):44-9.

Bouzari Z, Firoozabadi S, Hasannasab B, Emamimeybodi S, Golsorkhtabar-Amiri M. Maternal and neonatal outcomes in HELLP syndrome, partial HELLP syndrome and severe pre-eclampsia: eleven years’ experience of an obstetric center in the North of Iran. World Applied Sciences Journal. 2013;26(11):1459-63.

Pourrat O, Valère G, Pierre F. Is incidental gestational thrombocytopaenia really always safe for the neonate? J Obstet Gynaecol. 2014;34(6):499-500.

Yuce T, Acar D, Kalafat E, Alkilic A, Cetindag E, Soylemez F. Thrombocytopenia in pregnancy: do the time of diagnosis and delivery route affect pregnancy outcome in parturients with idiopathic thrombocytopenic purpura? Int J Hematol. 2014;100(6):540-4.

Yassaee F, Eskandari R, Amiri Z. Pregnancy outcomes in women with idiopathic thrombocytopenic purpura. Iran J Reprod Med. 2012;10(5):489-92.

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

Pafumi C, Valenti O, Giuffrida L, Colletta G. Gestational thrombocytopenia: does it cause any maternal and /or perinatal morbidity? Cukurova Med J. 2013;38(3):349-57.