Effect of mild preoperative thrombocytopenia on postpartum hemorrhage after cesarean deliveries.
- 2021
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.