Etiology and Fetomaternal Outcomes of Thrombocytopenia During Pregnancy

Nayana Gaba, Saurabh Gaba

Abstract

Background and Aim: Literature is scarce on thrombocytopenia during pregnancy; hence, this study was done to establish its etiology and the fetomaternal outcome.

Materials and Methods: This was a prospective observational study on 120 pregnant women with thrombocytopenia. Bleeding manifestations before delivery, intrapartum complications, and fetal outcomes were evaluated.

Results: At term, the platelet count was < 50,000/μL in 47.5% of the women; 50,000/μL to 1,00,000/μL in 48.3%; and > 1,00,000/μL in 4.2%. The etiologies were gestational thrombocytopenia (GT; 53.3%); syndrome of hemolysis, elevated liver enzyme levels and low platelet count (35%); abruption-induced disseminated intravascular coagulation (4.2%); malaria (3.3%); dengue (3.3%); and immune thrombocytopenic purpura (ITP, 0.8%). Overall, 3.2% of the women had bleeding manifestations before delivery; 15.8% had primary postpartum hemorrhage; and 24.5% had other intrapartum complications such as incision site ooze, wound hematoma, episiotomy hematoma, and placental abruption.

A weak positive correlation was observed between maternal and fetal platelet counts, and no significant association between maternal thrombocytopenia and neonatal complications was noted. A statistically significant association was found between maternal thrombocytopenia and stillbirths (P < .001). One neonate had intracranial hemorrhage. Platelet counts returned to normal within 6 weeks in all women except the one with ITP.

Conclusion: GT, the most prevalent cause of pregnancy-related thrombocytopenia, is associated with better fetomaternal outcomes compared with other etiologies. Early interdisciplinary evaluation of thrombocytopenia during pregnancy can help in optimizing care as adverse outcomes and management depend on the etiology.