Prevalence and Characterization of Thrombocytopenia in Pregnancy in Indian Women

  • Singh Nisha
  • Dhakad Amita
  • Singh Uma
  • A. K. Tripathi
  • Sankhwar Pushplata
Original Article

Abstract

To find the prevalence and causes of thrombocytopenia during pregnancy. An analytical prospective observational study was conducted in Department of Obstetrics & Gynecology, CSMMU, Lucknow. 1079 antenatal women screened for thrombocytopenia and investigated for cause and management strategies and fetomaternal outcome were recorded. Prevalence of thrombocytopenia was 8.8%. Gestational thrombocytopenia was seen in 64.2%, obstetric in 22.1% and medical in 13.68% cases. Mean platelet count in controls was lower with a significant fall (P < 0.001) in the platelet count as pregnancy advanced. Hypertensive and hepatic disorders were the most common obstetric causes of thrombocytopenia. Mode of delivery was not affected by thrombocytopenia. Maternal morbidity and mortality was seen only in medical and obstetric thrombocytopenia. The low platelet counts and declining trend with increasing gestational age predispose Indian women to risk of thrombocytopenia and a routine platelet count is suggested.

Keywords

Platelet count Gestational thrombocytopenia Obstetric thrombocytopenia DIC Medical thrombocytopenia Pregnancy with ITP 

References

  1. 1.
    Shehata N, Burrows R, Kelton JG (1999) Gestational thrombocytopenia. Clin Obst Gynaecol 42(2):327–334CrossRefGoogle Scholar
  2. 2.
    Burrows RF, Kelton JG (1990) Thrombocytopenia at delivery (a prospective survey of 6,715 deliveries). Am J Obstet Gynaecol 162:731–734Google Scholar
  3. 3.
    Sullivan CA, Martin JN Jr (1995) Management of the obstetric patients with thrombocytopenia. Clin Obstet Gynecol 38:521–534PubMedCrossRefGoogle Scholar
  4. 4.
    Magann EF, Martin JN (1999) Twelve steps to optical management of HELLP syndrome. Mississippi & Tennessee classification systems for HELLP syndrome. Clin Obstet Gynecol 42(3):532–550PubMedCrossRefGoogle Scholar
  5. 5.
    Sainio S, Kekomaki R, Rikonen S, Teramo K (2000) Maternal thrombocytopenia at term: a population-based study. Acta Obstetr Gynecol Scand 79(9):744–749CrossRefGoogle Scholar
  6. 6.
    Mathews JH, Benjamin S, Gill DS, Smith NA (1990) Pregnancy associated thrombocytopenia definition, incidence and natural history. Acta Hematol 84:24–29CrossRefGoogle Scholar
  7. 7.
    Boehlen F, Hohfeld P et al (2000) Platelet count at term pregnancy: a reappraisal of the threshold. Obstet Gynecol 95(1):29–33PubMedCrossRefGoogle Scholar
  8. 8.
    Karim R, Sacher RA (2004) Thrombocytopenia in pregnancy. Curr Hematol Resp Mar 3(2):128–133Google Scholar
  9. 9.
    Fay RA, Hughes AO, Farron NT (1983) Platelets in pregnancy: hyper destruction in pregnancy. Obstet Gynecol 61:238–240PubMedGoogle Scholar
  10. 10.
    Verdy E, Bessons V, Dreygus M et al (1997) Longitudinal analysis of platelet count and volume in normal pregnancy. Thromb Haemost 77:806–807PubMedGoogle Scholar
  11. 11.
    Ajzenberg N, Dreyfus M, Kaplan C, Yvart J, Will B, Tichernia G (1998) Pregnancy associated thrombocytopenia revisited: assessment and follow-up of 50 cases. Blood 92:4573–4580PubMedGoogle Scholar
  12. 12.
    Silver RM, Branch DW, Scott JR (1995) Maternal thrombocytopenia in pregnancy: time for a reassessment. Am J Obstet Gynecol 173:479–482PubMedCrossRefGoogle Scholar
  13. 13.
    Aster RH (1990) Gestational thrombocytopenia: a plea for conservative management. N Engl J Med 323:264PubMedCrossRefGoogle Scholar
  14. 14.
    Kwon JY, Shin JC, Lee JW, Lee JK, Kim SP, Rha JG (2007) Predictors of ITP in pregnant women presenting with thrombocytopenia. Int J Gynecolo Obstet 96(2):85–88CrossRefGoogle Scholar
  15. 15.
    F Gary Cunnigham, Kenneth J. Levenu, Steven L. Bloom, John C. Hawth, Larry C. Gilstrap III, Katharine D. Wenstrom. Hematological disorders: platelet disorders, 22nd edn. Williams Obstetrics, New York pp 1156–1158Google Scholar
  16. 16.
    Fischer R (2006) Thrombocytopenia in pregnancy. Emedicine article, www.emedicine.com/med/topic3480
  17. 17.
    American college of obstetricians and gynecologists (1999) ACOG practice bulletin. Thrombocytopenia in pregnancy. Number 6, September 1999. Clinical management guidelines for obstetrician-gynecologists. American college of obstetricians & gynecologists. Int J Gynaecol Obstet 67(2):117–28Google Scholar
  18. 18.
    Fonseca JE, Mendez F, Catano C, Arias F (2005) Dexamethasone treatment does not improve the outcome of women with HELLP syndrome: a double-blind, placebo-controlled, randomized clinical trial. Am J Obsetet Gynecol 193(5):1591–1598CrossRefGoogle Scholar
  19. 19.
    Laros RK Jr. (1994). Blood component therapy. ACOG Technical Bulletin, vol 199. The ACOG, Washinton DC, pp 1–5Google Scholar
  20. 20.
    McCrae KR, Samuals P, Schricber AD (1992) Pregnancy associated thrombocytopenia: pathogenesis and management. Blood 80:2697–2714PubMedGoogle Scholar
  21. 21.
    Suri V, Agrawal N, Saxena S, Malhotra P, Verma S (2006) Maternal and perinatal outcome in ITP with pregnancy. Acta Obst Gynae Scand 85(12):1430–1435CrossRefGoogle Scholar
  22. 22.
    Webert KE, Mittal R, Sigouin C, Heddle NM, Kelton JG (2003) A retrospective 11 year analysis of obstetric patients with ITP. Blood 102(13):4306–4317PubMedCrossRefGoogle Scholar
  23. 23.
    Kelton JG (1983) Management of the pregnant patient with ITP. Ann Intern Med 99:796–800PubMedGoogle Scholar
  24. 24.
    Letsky EA, Greaves M (1996) Guidelines on the investigation and management of thrombocytopenia in pregnancy and neonatal alloimmune thrombocytopenia. Maternal and neonatal haemostasis working party of the haemostasis and thrombosis task force of the British Society for haematology. Br J Haematol 95:21–26PubMedGoogle Scholar

Copyright information

© Indian Society of Haematology & Transfusion Medicine 2011

Authors and Affiliations

  • Singh Nisha
    • 1
  • Dhakad Amita
    • 1
  • Singh Uma
    • 1
  • A. K. Tripathi
    • 2
  • Sankhwar Pushplata
    • 1
  1. 1.Department of Obstetrics & GynecologyCSM Medical UniversityLucknowIndia
  2. 2.Department of MedicineCSM Medical UniversityLucknowIndia

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