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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (1): 21-26    DOI: 10.31083/j.ceog.2020.01.4945
Original Research Previous articles | Next articles
Thrombocytopenia in pregnancy; prevalence, causes and fetomaternal outcome
N. Al-Husban1, *(), O. Al-Kuran1, M. Khadra1, K. Fram1
1Department of Obstetrics and Gynaecology, Jordan University Hospital and the University of Jordan, Amman, Jordan
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Background: Thrombocytopenia is seen in up to 12% of pregnancies. Most cases are due to benign gestational thrombocytopenia and have no adverse effects. It can, however, be due to underlying serious causes and can lead to adverse maternal and perinatal consequences. Objective: To discover the prevalence and causes of thrombocytopenia and the impact of its severity on feto-maternal outcome. Materials and Methods: This is a retrospective comparative study. Thrombocytopenia was defined as platelet count less than 150×109/L detected any time after 24 weeks gestation and averaged during prenatal visits. All thrombocytopenic pregnant patients who completed 24 weeks of gestation were included. Cases were then divided into mild (group 1, platelet count between 70 and 150×109/L) and moderate to severe (group 2, platelet count less than 70×109/L) thrombocytopenia. Results: The prevalence of thrombocytopenia in pregnant women was 7.20%. Benign gestational thrombocytopenia (BGT) accounted for 78.53%, with idiopathic (immune) thrombocytopenic purpura (ITP) accounting for 1.93%, pre-eclamptic toxaemia (PET)/HELLP syndrome accounting for 7.41%, drugs 7.23%, systemic lupus erythematosus (SLE) with or without antiphospholipid antibodies (APA) 0.84%, and various maternal diseases 4.04%. Compared with mild thrombocytopenic pregnant women (group 1), moderate to severe thrombocytopenic women (group 2) were at a significantly greater risk of caesarean section, antepartum hemorrhage (APH), postpartum hemorrhage (PPH), wound haematoma, intrauterine fetal death (IUFD), preterm delivery, and intrauterine growth restriction (IUGR). Conclusion: Thrombocytopenia is prevalent in this obstetric population with various obstetric and nonobstetric causes. The consequences of thrombocytopenia in pregnancy are mostly benign, but moderate to severe thrombocytopenia was associated with adverse obstetric and perinatal outcomes. This was due to the nature and severity of the underling maternal diseases and their medication. The authors recommend studying prospectively each of these thrombocytopenia-induced diseases in pregnancy.

Key words:  Maternal      Perinatal outcome      Pregnancy      Thrombocytopenia      Postpartum      Antepartum      Hemorrhage     
Published:  15 February 2020     
*Corresponding Author(s):  N. Al-Husban     E-mail:

Cite this article: 

N. Al-Husban, O. Al-Kuran, M. Khadra, K. Fram. Thrombocytopenia in pregnancy; prevalence, causes and fetomaternal outcome. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(1): 21-26.

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Table 1  — Maternal age, parity, and gestational age at diagnosis in groups 1 and 2.
CharacteristicsGroup 1
1, 302
Group 2
t valuep
Maternal age (±SD)25.3 (4.1)30 (6.5)8.024˂0.001
Parity mean (±SD)2 (0.9)4 (1.6)1.581˂0.017
Gestational age in weeks (±SD)30 (3)28 (1.3)22.923˂0.001
Table 2  — Different etiologies of thrombocytopenia.
BGT n (%)ITP, n (%)SLE, n (%)SLE and APA, n (%)PET/HELLP, n (%)DRUGS, n (%)OTHERS, n (%)
1, 302 (78.53%)32 (1.93%)10 (0.60%)4 (0.24%)123 (7.41%)120 (7.23%)67 (4.04%)
Table 3  — Category ‘others’ with different possible etiologies.
Maternal condition or diseaseNumber of patients (67)
Aplastic anaemia1
G6PD deficiency1
Rheumatoid arthritis3
Hodgkin’s lymphoma3
Heart diseases7
AIHA & splenectomy1
Chronic myeloid leukaemia (CML)1
Von Willebrand disease1
Evan’s syndrome1
Kidney transplant on Tacrolimus4
Bronchial asthma11
HBs Ag positivity6
Idiopathic pleural effusion1
Obstetric cholestasis4
Brain tumors1
Lymphoedema (right leg)1
Sickle cell & Thalassemia trait1
Thalassemia trait3
Generalized urticaria1
Glanzmann thrombasthenia2
Ulcerative colitis (UC)3
Table 4  — Prevalence of hypothyroidism and DM, mode of delivery, and type of anaesthetic in groups 1 and 2.
Group 1
1, 302
Group 2
p value
Hypothyroidism n (%)79 (6.07%)3 (0.84%)0.083
DM n (%)42 (3.22%)13 (3.65%)˂0.001
Vaginal delivery n (%)812 (62.36)180 (50.56%)˂0.001
C-sections n (%)490 (37.63%)176 (49.44%)˂0.001
GA n (%)7 (1.43%)172 (97.72%)˂0.001
SA n (%)445 (90.82%)0.00
EA n (%)38 (7.75%)4 (2.27%)0.083
Total n (%)1302 (78.53%)356 (21.47%)˂0.001
Table 5  — Feto-maternal outcome in groups 1 and 2.
Complication (fetomaternal)Group 1Group 2p value
APH n (%)1 (0.077%)14 (3.93)˂0.001
PPH n (%)2 (0.077%)15 (4.21%)0.163
Peripartum Hysterectomy n (%)0 (0.0%)11 (3.09%)
GI bleeding n (%)2 (0.15%)0 (0.0%)
Wound hematoma n (%)3 (0.23%)11 (3.09%)˂0.001
IUFD3 (0.23%)18 (5.06%˂0.001
Preterm deliveries12 (0.92%)56 (15.73%)˂0.001
IUGR7 (0.54%)4 (1.12%)˂0.001
TOP0 (0.0%)3 (0.84%)
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