Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 23 , ISSUE 11 ( November, 2019 ) > List of Articles

Original Article

Thrombocytopenia in Pregnancy Nearing Term: A Clinical Analysis

Minal Harde, Rakesh Bhadade, Rosemarie deSouza, Mrida Jhingan

Keywords : Hemolysis, elevated liver enzyme, and low platelet count syndrome, Infections, Preeclampsia, Spinal anesthesia, Thrombocytopenia in pregnancy

Citation Information : Harde M, Bhadade R, deSouza R, Jhingan M. Thrombocytopenia in Pregnancy Nearing Term: A Clinical Analysis. Indian J Crit Care Med 2019; 23 (11):503-508.

DOI: 10.5005/jp-journals-10071-23277

License: CC BY-NC 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Background and aim: Thrombocytopenia in pregnancy varies from benign to severe with fetomaternal complications. We aimed to evaluate thrombocytopenia in pregnant Indian females in third trimester mainly during labor and delivery. Materials and methods: It was a prospective observational study done in a tertiary care teaching public hospital over 1 year. Consecutive 150 pregnant patients admitted to labor ward with thrombocytopenia were analyzed for etiology of thrombocytopenia, severity, mode of delivery, type of anesthesia, and fetomaternal complications. SPSS version 17 was used for the analysis. Results: Most common cause of thrombocytopenia was preeclampsia 50 (33.3%) and preeclampsia with hemolysis, elevated liver enzyme, and low platelet count syndrome (HELLP syndrome) 31 (20.7%) together followed by gestational 42 (28%). Infectious causes such as malaria, dengue, and leptospirosis were found in 19 patients (12.7%). Moderate to severe thrombocytopenia was seen in preeclampsia, preeclampsia with HELLP syndrome, and infectious etiology. Eleven patients (7.3%) developed antepartum hemorrhage (APH), 24 (16%) postpartum hemorrhage (PPH), 12 (8%) required ICU admission, and 3 (2%) mortalities were noted. Fifteen neonates (10%) needed ICU admission. Complications were observed in preeclampsia with HELLP syndrome (82%) and infectious causes (18%) and none in gestational. Sixty-eight patients underwent lower segment cesarean section (LSCS), among them 41 (27.3%) were given spinal anesthesia (SA) and none of them developed any neurological complications. Conclusion: Study widened the spectrum of causes for thrombocytopenia in pregnant patients. Preeclampsia with or without HELLP syndrome and vector-borne infections such as malaria, dengue, and leptospirosis were found to be very important causes of moderate to severe thrombocytopenia and were associated with complications. Spinal anesthesia is safe in parturients with mild thrombocytopenia. Awareness and vigilance about thrombocytopenia is vital to reduce maternal morbidity and mortality.


HTML PDF Share
  1. Gernsheimer T, James AH, Stasi R. How I treat thrombocytopenia in pregnancy. Blood 2013;121(1):38–47. DOI: 10.1182/blood-2012-08-448944.
  2. Nisha S, Dhakad A, Uma S, Tripathi AK, Pushpalata S. Prevalence and characterization of thrombocytopenia in pregnancy in Indian women. Indian J Hematol Blood Transfus 2012;28(2):77–81. DOI: 10.1007/s12288-011-0107-x.
  3. Saino S, Kekomaki R, Riikonon S, Teramo K. Maternal thrombocytopenia at term: a population-based study. Acta Obstet Gynecol Scand 2000;79(9):744–749. DOI: 10.1034/j.1600-0412.2000.079009744.x.
  4. 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 (ITP). Korean J Intern Med 2005;20(2):129. DOI: 10.3904/kjim.2005.20.2.129.
  5. Kam PC, Thompson SA, Liew AC. Review article, thrombocytopenia in the parturient. Anaesthesia 2004;59(3):255–264. DOI: 10.1111/j.1365-2044.2004.03576.x.
  6. Khellaf M, Loustau V, Bierling P, Michel M, Godeau B. Thrombocytopenia and pregnancy. Rev Med Interne 2012;33(8):446–452. DOI: 10.1016/j.revmed.2012.05.011.
  7. Harde M, Dave S, Vasave RR, Gujjar P, Bhadade R. Lower segment cesarean section in a patient with severe thrombocytopenia and pregnancy-induced hypertension. J Anaesthesiol Clin Pharmacol 2013;29(3):387–389. DOI: 10.4103/0970-9185.117110.
  8. Wang DP, Liang MY, Wang SM. Clinical analysis of pregnancy complicated with severe thrombocytopenia. Zhonghua Fu Chan KeZaZhi 2010;45(6):401–405.
  9. 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):163–168. DOI: 10.1016/j.ejogrb.2005.12.031.
  10. Chen Z, Liang MY, Wang JL. Etiology and clinical characteristics of pregnancy-emerged thrombocytopenia. Zhonghua Fu Chan KeZaZhi 2011;46(11):834–839.
  11. Brychtová P, Procházka M, Lattová V, Lubušký M, Procházková J, Slavík L, et al. Occurrence, etiology and clinical significance of thrombocytopenia in pregnancy. Ceska Gynekol 2013;78(6):560–565.
  12. Szkodny E, Sikora J, Bakon I, Zietek J. Pregnancy and delivery in women with thrombocytopenia. Ginekol Pol 2001;72(12A):1296–1299.
  13. Mbanya D, TayouTagny C, Takoeta E, Mbu R, Kaptue L. Factors associated with thrombocytopenia among pregnant women in Cameroon. Sante 2007;17(4):213–217. DOI: 10.1684/san.2007.0085.
  14. Chitra TV, Panicker S. Maternal and fetal outcome of dengue fever in pregnancy. J Vector Borne Dis 2011;48(4):210–213.
  15. Ismail NA, Kampan N, Mahdy Z, Abdul Jamil MA, Mohd Razi ZR. Dengue in pregnancy. Southeast Asian J Trop Med Public Health 2006;37(4):681–683.
  16. Jeffrey AL, Lance DM. Thrombocytopenia in pregnancy. J Am Board Fam Pract 2002;15:290–297.
  17. Varghese S, Kour G, Dhar T. Thrombocytopenia in pregnancy in a tertiary care hospital: a retrospective study. Int J Reprod Contracept Obstet Gynecol 2016;5:1532–1535. DOI: 10.18203/2320-1770.ijrcog20161318.
  18. 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):44–49. DOI: 10.1111/jog.12496.
  19. Goodier CG, Lu JT, Hebbar L, Segal BS, Goetzl L. Neuraxial anesthesia in parturients with thrombocytopenia: a multisite retrospective cohort study. Anesth Analg 2015;121(4):988–991. DOI: 10.1213/ANE.0000000000000882.
  20. Dikman D, Elstein D, Levi GS, Granovsky-Grisaru S, Samueloff A, Gozal Y, et al. Effect of thrombocytopenia on mode of analgesia/anesthesia and maternal and neonatal outcomes. J Matern Fetal Neonatal Med 2014;27(6):597–602. DOI: 10.3109/14767058.2013.836483.
  21. Lee LO, Bateman BT, Kheterpal S, Klumpner TT, Housey M, Aziz MF. Risk of epidural hematoma after neuraxial techniques in thrombocytopenic parturients. Anesthesiology 2017;126(6): 1053–1064. DOI: 10.1097/ALN.0000000000001630.
  22. Ozdemir S, Gorkemli H, Acar A, Celik C, Kayikcioglu E. A comparison of maternal and fetal outcomes of pregnancies complicated by moderate to severe thrombocytopenia caused by gestational thrombocytopenia preeclampsia/HELLP syndrome and immune thrombocytopenic purpura. Gynecology Obstetrics & Reproductive Medicine 2016;14(3):154–158.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.