Physiology/Endocrinology
Poster Session 3
.jpg "Lisa R. Thiele, MD MPH (she/her/hers) photo")
Lisa R. Thiele, MD MPH (she/her/hers)
Resident
UT Southwestern Medical Center
Dallas, TX, United States
Donald D. McIntire, PhD
University of Texas Southwestern Medical Center
Richardson, TX, United States
Elaine L. Duryea, MD
Assistant Professor
University of Texas Southwestern Medical Center
Dallas, TX, United States
David B. Nelson, MD (he/him/his)
Associate Professor
University of Texas Southwestern Medical Center
Dallas, TX, United States
Catherine Y. Spong, MD
Professor and Chair
University of Texas Southwestern Medical Center
Dallas, TX, United States
Recent studies have demonstrated an increased incidence of postpartum hemorrhage (PPH) among patients presenting for delivery with mild thrombocytopenia. Our objective was to evaluate the effect of thrombocytopenia at delivery on rates of PPH and anemia in the immediate postpartum period.
Study Design:
This was a retrospective cohort study of all patients delivering at a single academic institution. Patients with HELLP syndrome and pre-eclampsia with severe features were excluded. Cohorts included normal platelet count (³150k), mild thrombocytopenia (100k–149k), and moderate/severe thrombocytopenia (< 100k) on admission for delivery. Perinatal outcomes were obtained from an obstetric database with clinical data entry by trained research nurses. The primary analysis was to evaluate the frequency of PPH according to platelet count on admission. Secondary outcomes included hematocrit levels, anemia prior to discharge, and transfusion. Outcomes were compared using chi-square for categorical measures and ANOVA for continuous measures. Multiple comparisons were made using the Tukey-Kramer adjustment.
Results:
Between Jan 2019 and Dec 2020, 21,640 met inclusion criteria with 133 (6/1,000) patients having moderate/severe thrombocytopenia. Patients with moderate/severe thrombocytopenia on admission had significantly higher rates of PPH compared with those with normal or mildly decreased platelet levels. (Table) Patients with moderate/severe thrombocytopenia had higher average hematocrit levels (32.0 + 3.4%) immediately postpartum and lower anemia rates (30%) compared with patients with normal platelet levels (30.9 + 3.6%, 35%). Rate of transfusion postpartum was similar among all three cohorts.
Conclusion:
Patients with moderate/severe thrombocytopenia on admission for delivery had significantly higher rates of PPH compared with patients with normal or mildly decreased platelet levels. However, this increase did not translate to increased rates of transfusion or postpartum anemia.