Analysis of Thrombocytopenia in Pregnancy: Etiology, Fetal & Maternal Outcome

Introduction: Platelet count below 1.5 lakh/cu mm is called as thrombocytopenia. After anemia it is the second most common hematological disorder in pregnancy of 6-10% incidence. Gestational thrombocytopenia is the most common clinically benign thrombocytopenic disorder usually occurring in late pregnancy. 1) After anemia it is the second most common hematological disorder in pregnancy. 2) It affects nearly 6 to 15%; on an average 10% of all pregnancies. 3) Thrombocytopenia is categorized into:[2] a) MILD-1lakh to 1.5lakh/cu mm b) MODERATE-50,000 to 1lakh/cu mm c) SEVERE-less than 50,000/cu mm 4) The aim of antenatal management in patients with thrombocytopenia is to achieve and maintain a 'safe' rather than normal platelet count.[3] 5) The current guidelines consider that vaginal delivery is safe when platelet count is higher than 30,000/cu mm. For operative vaginal or cesarean deliveries, the safe platelet count should be at least 50,000 platelets/cu mm [4] 6) The exact platelet number needed to achieve a safe epidural anesthesia is debated, but in most guidelines, the reference value is around 75.000-80.000/cu mm. 7) Major mechanisms for thrombocytopenia are decreased production and increased destruction of platelets, platelet sequestration, and haemodilution. 8) Thrombocytopenia may also be the primary manifestation of viral infections (HIV, EBV, CMV) or result of adverse reaction of certain drugs (heparin, antibiotics, nonsteroidal anti-inflammatory drugs, diuretics). Maternal outcomes such as placental abruption, Post Partum Haemorrhage (PPH), Coagulation abnormalities and need for blood transfusions were studied. Fetal outcomes including Respiratory distress (RD) to baby, Meconium Aspiration Syndrome (MAS), admission to the Neonatal intensive care unit (NICU) and Intrauterine Demise (IUD) were studied. Objectives: To determine etiology of thrombocytopenia in pregnancy and to study fetomaternal outcome. Materials/Methods: A prospective observational study was conducted for 2 months in June, July 2022 in the department of Obstetrics and Gynecology, Government General Hospital, Nizamabad. All pregnant women admitted with platelet count below 1.5l lakh/ cu mm in third trimesterwere included in this study.Results: Out of 1156 patients taken for study, 71(6.1%) were found to have thrombocytopenia.Gestational thrombocytopenia accounted for majority (70.44%) of cases of thrombocytopenia in pregnancy followed by hypertensive disorders (28.16%) and ITP (1.4%).Among 71patients with thrombocytopenia, there were no complications in 49.29% patients, most common is PPH (47.8%), followed by coagulation failure, abruption, HELLP and AKI.There were no neonatal complications in 47.8% cases, respiratory distress in 23.94% cases, intra uterine death in 7.04% cases and others (38.02%).