Title: Comparative study of perinatal outcome in pregnant patients with thrombocytopenia and those with normal platelet count
Authors: Dr Rinku G, Dr Sapna Devi D P
DOI: https://dx.doi.org/10.18535/jmscr/v8i12.24
Abstract
Background: Thrombocytopenia is the second commonest hematological disorder in pregnancy and may result from diverse etiologies.
Aim and Objectives: The study aims to investigate the risk factors, complications and perinatal outcome of pregnancies complicated by thrombocytopenia.
Materials and Methods: A comparative cross sectional study was conducted in Department of obstetrics and Gynaecology, Govt. Medical College, Trivandrum for a period of one year.
Study Population: Include all pregnant women with thrombocytopenia delivering in Department of obstetrics and Gynaecology, Govt. Medical College, Trivandrum, during one year period and comparing them with equal number of antenatal women without thrombocytopenia.
Results: In the present study gestational thrombocytopenia was the commonest cause of thrombocytopenia (40%) followed by severe pre eclampsia and HELLP syndrome.44% delivered preterm due to complicating factors like HELLP, APLA syndrome and abruptio placenta and IUGR. Cesarean rates were higher among cases. Still birth rates (18% v/s 0.6%) and NND (4.8% v/s 0.6%) were high in the study group. Neonatal thrombocytopenia was found in 7 cases (p = 0.007) in thrombocytopenia group.
Conclusion: Gestational thrombocytopenia and ITP had a favorable outcome in the present study. The rare and serious types of thrombocytopenoa like thrombotic thrombocytopenic purpura, APLA syndrome were associated with placental abruption, low APGAR scores and still birth.Careful surveillance help in early detection of complications and timely intervention results in reduced maternal and perinatal mortality.
Keywords: Thrombocytopenia, HELLP, Perinatal outcome.
References
- Boehlen F. et al. 2000) Platelet count at term pregnancy: A reappraisal of the threshold. Obstet Gynecol 95:29,2000.
- Provan D et al: International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 15:168-186, 2010.
- Magann EF et al: Twelve steps to optimal management of HELLP syndrome. Clin Obstet Gynecol ; 42:532-550,1999.
- Burrows R. et al, Thrombocytopenia at delivery: A prospective survey of 6,715 deliveries. Am J ObstetGynecol 1990: 162:731-734,1990.
- Sullivan CA et al. Management of the obstetric patient with thrombocytopenia. Clin Obstet Gynecol ; 38:521-534,1995.
- P.et al Thrombocytopenia in Pregnancy. Hematology/Oncology Clinics of North America, Volume 25. Issue 2, Pages 293-310,2011.
- Adams RJ et al: Maternal Thrombocytopenia in Pregnancy. Clinics in Laboratory Medicine; Volume 33, Issue 2, Pages 327-341,2013.
- Silver RM, Branch DW, Scott JR: Maternal Thrombocytopenia in pregnancy. Time for reassessment. Am JObstet and Gynecol:173:479-82,1995.
- Meti S et al: Successful pregnancy in a case of congenital thrombotic thrombocytopenic purpura J Obstet Gynaecol, 30(5):519-521,2010.
- Payne SD, Resnik R. Moore TR, Hedriana HL Kelly TF. Maternal characteristics and risk of severe neonatal thrombocytopenia and intracranial hemorrhage in pregnancies complicated by autoimmune thrombocytopenia. Am J Obstet Gynecol; 177: 149-55,1997.
- R. etal: Study of mild versus moderate to severe thrombocytopenia in third trimester of pregnancy in a tertiary care hospital, NHL Journal of Medical Sciences/Jan 2014/Vo I 3/issue 1.
- S et al. Thrombocytopenia during pregnancy. Journal of evolution of medical and dental science.2010 Month: October Volume 3(5), 12956-12960,2010.
- s et al. Moderate to severe thrombocytopenia during pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology, 5(1) 132-133,2007.
- Chao et al: Thrombocytopenia in pregnancy and neonatal outcomes. Zhongguo Dang Dai Br Ke Za Zhi. 201 1 Oct; 13(10):790-3.
- George JN, Wolf SH: Idipathic thrombocytopenic Purpura: A practice guideline developed by explicit methods for the American society of hematology. Blood 88: 3,1996.
- Ruggeri M at al: Gestational thrombocytopenia: a prospective study. Haematological. May-Jun: 82(3):341-2,1997.
- Katke RD et al. Thrombocytopenia during pregnancy: an institutional based study. Int J Reprod Contracept Obstet Gynecol. :3(4): 947-957,2014.