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Effect of mild preoperative thrombocytopenia on postpartum hemorrhage after cesarean deliveries.

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Citation: American Journal of Obstetrics & Gynecology MFM. 3(4):100368, 2021 07.PMID: 33831587Institution: MedStar Washington Hospital Center | MedStar Washington Hospital CenteretsuyaDepartment: Maternal-Fetal Medicine Fellowship | Obstetrics & Gynecology Residency | Obstetrics and Gynecology/Maternal-Fetal MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Postpartum Hemorrhage | *Thrombocytopenia | Cesarean Section/ae [Adverse Effects] | Female | Gestational Age | Humans | Postpartum Hemorrhage/ep [Epidemiology] | Pregnancy | Retrospective Studies | Thrombocytopenia/ep [Epidemiology]Year: 2021 ISSN:

2589-9333

Name of journal: American journal of obstetrics & gynecology MFMAbstract: BACKGROUND: Thrombocytopenia at time of delivery is considered to be a risk factor for postpartum hemorrhage. However, platelet count thresholds for postpartum hemorrhage are variable and not extensively studied.CONCLUSION: Preoperative mild thrombocytopenia was not associated with postpartum hemorrhage, red blood cell transfusion, wound complications, or postpartum Emergency Department visits in women undergoing cesarean delivery. Copyright (c) 2021. Published by Elsevier Inc.OBJECTIVE: To examine if mild thrombocytopenia is associated with an increased risk of postpartum hemorrhage among women undergoing cesarean delivery.RESULTS: Of 3,133 women, 2,799 (89.3%) had normal platelet levels, 298 (9.5%) had mild thrombocytopenia, and 36 (1.2%) had moderate to severe thrombocytopenia. There were no differences in the risks of postpartum hemorrhage, need for a red blood cell transfusion, wound complications or postpartum Emergency Department visit comparing women with normal platelet counts to those with mild thrombocytopenia (24.6% vs. 25.8% [aOR 1.16; 95%CI 0.88-1.54]; 6.5% vs 6.7% [aOR 1.34; 95%CI 0.80-2.24]; 4.5% vs. 5.4% [aOR 1.53; 95%CI 0.88-2.64]; 9.0% vs. 10.7% [aOR 1.37; 95%CI 0.92-2.03, respectively).STUDY DESIGN: This was a retrospective cohort study of all women who underwent a cesarean delivery at a tertiary care hospital Labor and Delivery unit from September 2015 to June 2018. Women with normal platelet counts (>=150,000/microL) were compared to women with mild thrombocytopenia (100-149,000/microL). Women were excluded if they had moderate to severe thrombocytopenia (platelet count less than 100,000/microL) or had received a platelet transfusion. The primary outcome was postpartum hemorrhage (quantitative blood loss >=1000 mL). Secondary outcomes included frequencies of red blood cell transfusion, wound complications (surgical site infections, dehiscence, or hematoma), and postpartum Emergency Department visits. Adjusted odds ratios (aOR) with 95% confidence intervals (95%CI) were calculated, controlling for maternal age, gestational age, BMI, scheduled cesarean, hypertension, and pre-operative hemoglobin level.All authors: DiSciullo A, Kawakita T, Landy H, Mokhtari NOriginally published: American Journal of Obstetrics & Gynecology MFM. :100368, 2021 Apr 05Fiscal year: FY2022Fiscal year of original publication: FY2021Original title: Condensation: Mild gestational thrombocytopenia does not confer increased risk for postpartum hemorrhage or red blood transfusion for women undergoing cesarean delivery.Digital Object Identifier:

https://dx.doi.org/10.1016/j.ajogmf.2021.100368

Date added to catalog: 2021-06-07

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Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	33831587	Available		33831587

BACKGROUND: Thrombocytopenia at time of delivery is considered to be a risk factor for postpartum hemorrhage. However, platelet count thresholds for postpartum hemorrhage are variable and not extensively studied.

CONCLUSION: Preoperative mild thrombocytopenia was not associated with postpartum hemorrhage, red blood cell transfusion, wound complications, or postpartum Emergency Department visits in women undergoing cesarean delivery. Copyright (c) 2021. Published by Elsevier Inc.

OBJECTIVE: To examine if mild thrombocytopenia is associated with an increased risk of postpartum hemorrhage among women undergoing cesarean delivery.

RESULTS: Of 3,133 women, 2,799 (89.3%) had normal platelet levels, 298 (9.5%) had mild thrombocytopenia, and 36 (1.2%) had moderate to severe thrombocytopenia. There were no differences in the risks of postpartum hemorrhage, need for a red blood cell transfusion, wound complications or postpartum Emergency Department visit comparing women with normal platelet counts to those with mild thrombocytopenia (24.6% vs. 25.8% [aOR 1.16; 95%CI 0.88-1.54]; 6.5% vs 6.7% [aOR 1.34; 95%CI 0.80-2.24]; 4.5% vs. 5.4% [aOR 1.53; 95%CI 0.88-2.64]; 9.0% vs. 10.7% [aOR 1.37; 95%CI 0.92-2.03, respectively).

STUDY DESIGN: This was a retrospective cohort study of all women who underwent a cesarean delivery at a tertiary care hospital Labor and Delivery unit from September 2015 to June 2018. Women with normal platelet counts (>=150,000/microL) were compared to women with mild thrombocytopenia (100-149,000/microL). Women were excluded if they had moderate to severe thrombocytopenia (platelet count less than 100,000/microL) or had received a platelet transfusion. The primary outcome was postpartum hemorrhage (quantitative blood loss >=1000 mL). Secondary outcomes included frequencies of red blood cell transfusion, wound complications (surgical site infections, dehiscence, or hematoma), and postpartum Emergency Department visits. Adjusted odds ratios (aOR) with 95% confidence intervals (95%CI) were calculated, controlling for maternal age, gestational age, BMI, scheduled cesarean, hypertension, and pre-operative hemoglobin level.

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