BACKGROUND AND PURPOSE:

• DiSciullo et al. (AJOG Maternal-Fetal Medicine, 2021) assessed whether mild thrombocytopenia is associated with an increased risk of postpartum hemorrhage among women undergoing cesarean delivery

METHODS:

• Retrospective cohort study
• Population
  • All women undergoing cesarean delivery at a hospital from September 2015 to June 2018
  • Exclusion: Women with moderate to severe thrombocytopenia or women who required a platelet transfusion
• Exposure
  • Normal platelet counts (≥150,000/μL)
  • Mild thrombocytopenia (100 to 149,000/μL)
• Study design
  • Adjusted odds ratios (aOR) were calculated
  • Covariates included in adjustments included: Maternal age | Gestational age | BMI | Scheduled cesarean | Hypertension | Preoperative hemoglobin level
• Primary outcome
  • PPH (quantitative blood loss ≥1000 mL)
• Secondary outcomes
  • Frequencies of red blood cell transfusion
  • Wound complications (SSIs, dehiscence, or hematoma)
  • Postpartum Emergency Department (ED) visits

RESULTS:

• 3133 women
  • Normal platelet levels: 89.3%
  • Mild thrombocytopenia: 9.5%
  • Moderate to severe thrombocytopenia (excluded): 1.3%
• No differences were seen between normal platelet and mild thrombocytopenia groups for the following
  • Postpartum hemorrhage
    • Normal: 24.6%
    • Mild thrombocytopenia: 25.8%
    • aOR 1.16 (95% CI, 0.88 to 1.54)
  • Need for a red blood cell transfusion
    • Normal: 6.5%
    • Mild thrombocytopenia: 6.7%
    • aOR 1.34 (95% CI, 0.80 to 2.24)
  • Wound complications
    • Normal: 4.5%
    • Mild thrombocytopenia: 5.4%
    • aOR 1.53 (95% CI, 0.88 to 2.64)
  • Postpartum ED visits
    • Normal: 9.0%
    • Mild thrombocytopenia: 10.7%
    • aOR 1.37 (95% CI, 0.92 to 2.03)

CONCLUSION:

• For women undergoing cesarean delivery, mild thrombocytopenia at the time of delivery did not increase the risk for postpartum hemorrhage, need for transfusions, or wound complications
• The authors conclude

Our study found no increased risk of PPH or need for red blood cell transfusion in women with mild thrombocytopenia undergoing a cesarean delivery

These negative findings support the exclusion of mild thrombocytopenia as a risk factor for PPH in safety bundle protocols

Learn More – Primary Sources:

Mild gestational thrombocytopenia does not confer increased risk for postpartum hemorrhage or red blood transfusion for women undergoing cesarean delivery

Related ObG Topics:

Thromboelastography (TEG): A Point-Of-Care Tool to Assess Coagulopathy During PPH

Gestational Thrombocytopenia: What is the Threshold for Further Follow-Up?

Mild Thrombocytopenia: Is it a Risk Factor for Postpartum Hemorrhage?