The risk of postpartum hemorrhage (PPH) is increased nearly 2-folds among pregnant women with mild thrombocytopenia, according to the findings of a recent study, which were presented at the 43rd Annual Pregnancy Meeting of the Society for Maternal-Fetal Medicine in February.¹

For this they enrolled 305,794 women with singleton pregnancies who had given birth at full term between 2008 and 2020. Baseline platelet count ranging from 100-149k/ μL was designated mild thrombocytopenia for the study, while normal platelet counts were ≥150k/μL.

Retrospective analysis of data showed a small but statistically significant increase in the rate of packed red blood cell (pRBC) transfusions in the postpartum period, which was the primary outcome of the study, among women with mild thrombocytopenia during pregnancy compared to women with normal platelet count; 1.2% vs 0.9%, respectively with adjusted odds ratio of1.50. Women with mild thrombocytopenia (27.6%) required transfusion of two or more pRBCs than those with normal platelet level (22.5%). They also had higher occurrence of PPH with blood loss ≥1000mL at 2.4% vs 2.0%, respectively with aOR of 1.34. More women with mild thrombocytopenia required uterotonics (such as methylergonovine, misoprostol and carboprost tromethamine) and additional procedures such as dilation and curettage (D&C), peripartum hysterectomy and uterine artery embolization (0.6% vs 0.4%; aOR 1.25).

Hence, early detection of mild thrombocytopenia during pregnancy and thereby identification of women at risk of PPH is essential. This enables formulating a management plan along with close monitoring of such cases to preempt adverse maternal outcomes.

Reference

1. Post RJ, et al. Abstract 97. Risk of postpartum hemorrhage and blood transfusion with mild thrombocytopenia. Am J Obstet Gynecol. 2023;228 (1 Suppl); S80-S81. DOI: https://doi.org/10.1016/j.ajog.2022.11.176.