Prospective study of thrombocytopenia in pregnancy

Abstract

Aim: To study the prevalence, causes, treatment and outcome of thrombocytopenia in pregnancy. Methods: 15,721 antenatal women were screened for thrombocytopenia using automated blood counter. Women with thrombocytopenia were further evaluated using history, clinical examination & investigations to diagnose the cause of thrombocytopenia. These women were treated appropriately according to the cause and followed up to know the outcome of thrombocytopenia in pregnancy. Results: Out of 15,721 patients screened, 1,212 patients had thrombocytopenia (7.7%). 949 patients found to have gestational thrombocytopenia accounting for 78.3% of all thrombocytopenic patients. Hypertension complicating pregnancy was the second major cause (15.01%). 1.60% of thrombocytopenic women had ITP. Other causes were fever complicating pregnancy (50 patients), Bone marrow disorders (2 patients), and Jaundice complicating pregnancy (9 cases). Platelet count normalized within 2 weeks of delivery without treatment in gestational thrombocytopenia patients. All the patients with ITP and Aplastic anaemia responded well to steroids. Patients with fever and liver disease complicating pregnancy were treated supportively. Platelets transfused in all patients with severe thrombocytopenia to avoid hemorrhagic complications during delivery. Maternal morbidity and mortality was high in hypertension complicating patients. Regarding perinatal outcome only 2 neonates of ITP mothers had platelet count < 50,000/cumm (one delivered by vaginal and other by LSCS) but none of them developed hemorrhagic complications. Conclusion: Prevalence of thrombocytopenia in pregnancy is 7.7%. Gestational thrombocytopenia is the major cause of thrombocytopenia in pregnancy (78.9%). Platelet count > 1lakh/cumm and without past h/o thrombocytopenia should rise the doubt of Gestational thrombocytopenia. ITP should be considered in patients with past history of low platelets. Caesarean deliveries should be reserved for obstetric indications alone. For gestational thrombocytopenia normalization of platelet count after delivery is necessary.