Thrombocytopenia in pregnancy: an observational study

ABSTRACT

To determine the etiology, and outcome of thrombocytopenia in pregnancy. An Observational hospital based study was conducted at Isra University hospital Hyderabad for three years from 1[st] January 2009 to 31[st] December 2011. Total 3576 obstetric patients were admitted in Obstetrics and Gynecology department during this period of whom 71[1.9%] had thrombocytopenia in pregnancy. Depending on the number of platelets; thrombocytopenia was divided into four groups, i.e. those having platelets below 20,000, between 20-50,000, between 50-100,000 and more than 100,000. Patients with chronic liver disease and drug induced thrombocytopenia were excluded from the study. A predesigned structured proforma was used. All results were analyzed on statistical software SPSS version 16 Frequencies and percentages were calculated, the final outcome was recorded. The most common cause of thrombocytopenia was gestational thrombocytopenia seen in 24[33.8%] patients followed by HELLP syndrome 9 [26.7%] and hepatitis E in 10[16.3%] patients. There were 11 cases who had platelets below 20,000, 18 had levels between 20-50,000 and 19 had between 50-100,000. The common symptoms were bleeding seen in 30[42.2%] cases and purpura or easy bruising seen in 11[15.4%] cases while, 30 cases were asymptomatic. Of 11 cases that had platelets below 20,000, 10 mothers died along with their 7 babies while, only 3 surviving babies were those of mothers dying of post partum hemorrhage. Eighteen mothers had platelets between 20-50,000 and out of these 9 mothers and 11 neonates died. Nineteen mothers had platelets between 50-100,000 and out of these one mother and 3 neonates died. Overall maternal mortality was 20[28.1%]. Maternal and fetal deaths occurred in almost all cases with DIG, HEV and malaria while, in PPH mothers died but their newborns survived irrespective of platelet count. Diseases causing platelets below 50,000 in pregnancy should be rated as high risk pregnancies and dealt with accordingly to reduce high fetal or maternal mortality