Please wait a minute...
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
Download:  PDF(1092KB)  ( 341 ) Full text   ( 26 )
Export:  BibTeX | EndNote (RIS)      
Abstract  

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:  husban48@yahoo.com

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.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.01.4945     OR     https://ceog.imrpress.com/EN/Y2020/V47/I1/21

Table 1  — Maternal age, parity, and gestational age at diagnosis in groups 1 and 2.
CharacteristicsGroup 1
1, 302
Group 2
356
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
Psoriasis1
Rheumatoid arthritis3
FMF2
Infections3
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
Epilepsy4
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
356
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%)
[1] Practice Bulletin No.166: "Thrombocytopenia in Pregnancy".Obstet. Gynecol., 2016, 128, 43.
[2] Burrows R.F.,Kelton J.G.:"Thrombocytopenia at delivery: A prospective survey of 6715 deliveries".Am. J. Obstet. Gynecol., 1990, 162, 731.
[3] Myers B.:"Thrombocytopenia in pregnancy".Obstetrician & Gynaecologist, 2009, 11, 177.
[4] Boehlen F.,Hohlfeld P.,Extermann P.,Perneger T.V.,de Moerloose P.:"Platelet count at term pregnancy: A reappraisal of the threshold".Obstet. Gynecol., 2000, 95, 29.
[5] Verdy E.,Bessous V.,Dreyfus M.,Kaplan C.,Tchernia G.,Uzan S.:"Longitudinal analysis of platelet count and volume in normal pregnancy".Thromb. Haemost., 1997, 77, 806.
[6] Susanna S.,Ritta K.,Seija R.,Kari T.:"Maternal thrombocytopenia at term: a population-based study".Acta. Obstet. Gynecol. Scand., 2000, 79, 744.
[7] Parnas M., Sheiner E., Shoham-Vardi I., Burstein E., Yermiahu T., Levi I., et al.:"Moderate to severe thrombocytopenia in pregnancy". Eur. J. Obstet. Gynecol.Reprod. Biol.: "Moderate to severe thrombocytopenia in pregnancy".Eur. J. Obstet. Gynecol.Reprod. Biol., 2006, 128, 163.
[8] Won Y. W., Moon W., Yun Y. S., Oh H.S., Choi J.H., Lee Y.Y., et al.: "Clinical aspects of pregnancy: "Clinical aspects of pregnancy and delivery in patients with chronic idiopathic thrombocytopenic purpura(ITP)".Korean J. Intern. Med., 2005, 20, 129.
[9] Gasparyan A.Y., Ayvazyan L., Mikhailidis D.P., Kitas G.D.:"Mean platelet volume:A link between thrombosis and inflammation"? Curr. Pharm. Des., 2011, 17, 47.
[10] Ekin A., Gezer C., Kulhan G., Avci M.E., Taner C.E.: "Can platelet count and mean platelet volume during the first trimester of pregnancy predict preterm premature rupture of membranes"?J. Obstet. Gynaecol. Res., 2015, 41, 23.
[11] Levy J.A., Murphy L.D.: "Thrombocytopenia in pregnancy".J. Am. Board Fam. Med., 2002, 15, 290.
[12] 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.
[13] Bowles K.M., Turner G.E., Wimperis J.Z.: "Resolution of chronic severe refractory thrombocytopenia after treatment of hypothyroidism".J. Clin. Pathol., 2004, 57, 995.
[14] Tahir H., Sheraz F., Sagi J., Daruwalla V.: "Immune thrombocy-topenia(ITP)secondary to subclinical Hashimoto’s Thyroiditis: Role of levothyroxine in improving the clinical outcome of ITP".J. Investig. Med. High Impact Case Rep., 2016, 4, 2324709616647085.
[15] Kang M.Y., Hahm J.R., Jung T.S., Lee G.W.,Kim D.R., Park M.H.: "A 20-year-old woman with Hashimoto’s Thyroiditis and Evans syndrome".Yonsei Med. J., 2006, 47, 432.
[16] Varner M.W.: "Autoimmune disorders and pregnancy".Semin. Perinatol., 1991, 15, 238.
[17] Li P., Shan Z., Zhou L., Xie M., Bao W., Zhang Y., et al.: "Mechanisms in endocrinology: Parity: "Mechanisms in endocrinology: Parity and risk of type 2 diabetes: a systematic review and dose-response meta-analysis".Eur. J. Endocrinol., 2016, 175, 231.
[18] “British Committee for Standards in Haematology General Haematology Task Force, Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy".Br. J. Haematol., 2003, 120, 574.
[19] Beilin Y., Zahn J., Comerford M .: "Safe epidural analgesia in thirty parturients with platelet counts between 69, 000 and 98 000 mm-3".Anesth. Analg., 1997, 85, 385.
[20] Moeller-Bertram T., Kuczkowski K.M., Benumof J.L.: "Uneventful epidural labor analgesia in a parturient with immune thrombocytopenic purpura and platelet count of 26, 000/mm3 which was unknown preoperatively".J. Clin. Anesth., 2004, 16, 51.
[21] Webert K.E., Mittal R., Sigouin C., Heddle N.M., Kelton J.G.: "A retrospective 11-year analysis of obstetric patients with idiopathic thrombocytopenic purpura".Blood, 2003, 102, 4306.
[22] Sibai B.M., Ramadan M.K., Usta I., Salama M., Mercer B.M., Friedman S.A.: "Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets(HELLP Syndrome)".Am. J. Obstet. Gynecol., 1993, 169, 1000.
[23] Magann E.F., Evans S., Hutchinson M., Collins R., Lanneau G., Morrison J.C.: "Postpartum hemorrhage after caesarean delivery: An analysis of risk factors".South Med. J., 2005, 98, 681.
[24] Cines D.B., Liebman H., Stasi R.: "Pathobiology of secondary immune thrombocytopenia".Semin. Hematol., 2009, 46, S2.
[25] Clowse M.E., Jamison M., Myers E., James A.H.: "A national study of the complications of lupus in pregnancy".Am. J. Obstet. Gynecol., 2008, 199, 127.e1.
[26] Moroni G., Doria A., Giglio E., Tani C., Zen M., Strigini F., et al.:"Fetal outcome: "Fetal outcome and recommendations of pregnancies in lupus nephritis in the 21st century: A prospective multicenter study".J. Autoimmun., 2016, 74, 6.
[27] Aly E.A.H.,Riyad R.M.,Mokbel A.N.:"Pregnancy outcome in patients with systemic lupus erythematosus: A single center study in the High Risk Pregnancy unit".Middle East Fertility Society Journal, 2016, 21, 168.
[28] Khan A,Thomas M.P. K. SD.: "Pregnancy complicated by systemic lupus erythematosus and its outcome over 10 years".J Obstet Gynaecol., 2018, 12, 1.
[29] Alkoky H., Baghdadi N., Al Saleh J.: "THU0331.βOutcome of pregnancy in patients with systemic lupus erythematosus: Prevalence of maternal, obstetric, and fetal complications".Ann. Rheum. Dis., 2016, 75, 306.
[30] Sujatha M., Meena M.: "A comparative study of maternal and perinatal outcome in patients with and without HELLP syndrome".Int J Reprod Contracept Obstet Gynecol., 2016, 6, 49.
[31] Eswari S.: "Study of maternal and fetal outcome in antepartum eclampsia in a tertiary care hospital".Int J Reprod Contracept Obstet Gynecol., 2018, 7, 1108.
[32] Lin Y.H., Lo L.M., Hsieh C.C., Chiu T.H., Hsieh T.T., Hung T.H.: "Perinatal outcome in normal pregnant women with incidental thrombocytopenia at delivery".Taiwan J. Obstet. Gynecol., 2013, 52, 347.
[1] Ali S. Alqahtani. Seroprevalence of Dengue virus among pregnant mothers and their-newborn infants in the southwest of Saudi Arabia[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 741-743.
[2] M. Elmahdy, I. Elfourtia, H. Maghraby. Office hysteroscopy in cases of recurrent implantation failure; Do or not to do[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 723-728.
[3] L.L. Xu, J.Q. Li, Y.Q. Pu, C. Zhou, S.W. Feng, Q. Luo. Effect of prenatal depression during late pregnancy on maternal and neonatal outcomes[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 681-686.
[4] Y.X. Wang, M. Zhong, H. Yi, H.F. He. Detection of group B streptococcus colonization in cervical and lower vaginal secretions of pregnant women[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 669-674.
[5] I.F. Urunsak, U.K. Gulec, E. Eser, M. Sucu, C. Akcabay, S. Buyukkurt. The role of dinoprostone for labor induction in postterm and high-risk term pregnancies[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 664-668.
[6] S. Han, S. Choi, S. Nah, Y.H. Lee. Preterm labor in mild carbon monoxide poisoning: a case report[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 805-806.
[7] C. Ji, L.J. Sun, L.T. Li, J. Ma, W.H. Ge, X. Zhao. Impact of clinical pharmacist intervention on blood glucose control and perinatal outcomes in gestational diabetes mellitus through a diabetes management system[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 645-652.
[8] H.S.O. Abduljabbar, H. Abduljabar. A systematic review and meta-analysis of the reported symptoms of Covid 19 in pregnancy[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 632-637.
[9] M. Varras, C. Loukas, N. Nikiteas, V.K. Varra, F.N. Varra, E. Georgiou. Comparison of laparoscopic surgical skills acquired on a virtual reality simulator and a box trainer: an analysis for obstetrics-gynecology residents[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 755-763.
[10] G. Garuti, E. Castellacci, S. Calabrese, S. Calzolari. Hysteroscopic removal of retained products of conception with enhanced vascularity: a study of reliability[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(4): 472-477.
[11] H.M. Kim, J.Y. Lee, W.J. Seong. Multidetector computed tomography to predict heavy bleeding and need for angiographic embolization in patients with postpartum hemorrhage[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(4): 478-482.
[12] N. Matsumoto, Y. Mori. High fibrin/fibrinogen degradation product and D-dimer levels for the diagnosis of invasive group A streptococcal infections during pregnancy[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(4): 483-489.
[13] H. Yolli, M.E. Demir, R. Yildizhan. Neutrophil gelatinase associated lipocalin-2 (Ngal) levels in preeclampsia[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(4): 519-523.
[14] K. Chikazawa, K. Imai, T. Kuwata, K. Takagi. Prophylactic laparoscopic adnexal surgery with low-pressure CO2 insufflation for ovarian cysts during the late first trimester or second trimester of pregnancy[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(4): 537-540.
[15] J. A. Villarreal-Rodriguez, L. G. Mancillas Adame, J. Maldonado-Sanchez, A. Guzmán-López, O. R. Treviño-Montemayor, J. G. Gonzalez-Gonzalez, D. Saldívar-Rodríguez. A randomized controlled trial comparing acarbose vs. insulin therapy for gestational diabetes in individuals with inadequate glycemic control by diet alone[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(4): 552-555.
No Suggested Reading articles found!