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Assessment of Post-partum Haemorrhage Risk among Women with Thrombocytopenia: A Cohort Study

S. Arcudi1, A. Ronchi2, M.W. Ossola2, E. Iurlaro2, M. Capecchi3,4, A. Artoni3, F. Peyvandi1,3

1University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy, 2Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Obstetrics and Gynecology, Milan, Italy, 3Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy, 4University of Milan, Department of Biomedical Sciences for Health, Milan, Italy

Abstract Number: PB2561

Meeting: ISTH 2020 Congress

Theme: Women Health » Pregnancy and Pregnancy Complications

Background: Post-partum haemorrhage (PPH) is a leading cause of maternal death globally. Several risk factors for PPH have been previously described, including uterine atony, retained placenta/membranes, maternal age>35y, foetal macrosomia and coagulopathies. A recent study found that thrombocytopenia conferred an increased risk of postpartum haemorrhage for caesarean or vaginal birth after a previous caesarean.

Aims: The aim of the study was to assess the PPH risk among women with platelet count below 100.000/mcl, regardless the type of delivery.

Methods: We performed a cohort study including consecutive women delivering in our Gynaecological Clinic between November 2018 to November 2019, with less than 100.000/mcl platelets at birth. Consecutive women with more than 150.000/mcl platelets were selected as controls and matched for age, type of birth and ethnicity.
Postpartum haemorrhage (PPH) was defined as ≥500mL blood loss for vaginal deliveries and ≥1000mL in caesarean sections, according to the WHO criteria. As estimates of relative risks, odds ratios (ORs) with their 95% confidence intervals (95% CI) were calculated according to the method of Woolf.

Results: Ninety women with less than 100.000/mcl platelets at delivery (platelet count range 46.000/mcl – 100.000/mcl) and ninety women with more than 150.000/mcl platelets were enrolled in the study. Mean age was 35 years (range 20-46). Demographic and clinical characteristics are listed in the table. The risk of PPH was 5-fold higher in women with thrombocytopenia compared to healthy controls (OR 4.6; 95% CI 2.1-10.1). When stratifying the analysis for the type of birth, the risk appeared to be slightly higher for vaginal delivery than for caesarean section (ORs 5.1 and 4.4 respectively).

Conclusions: A platelet count below 100.000/mcl appears to be a significant risk factor for PPH, and could help clinicians to identify women at higher-risk before delivery.

 Platelet count < 100.000/mclPlatelet count > 150.000/mcl
Age (mean, range)35 (20 – 46)35 (20 – 46)
Platelet count (*103/mcl) (mean, range)86 (46 – 100)237 (151 – 414)
Caucasian73 (81%)72 (79,9%)
Nulliparous56 (62%)43 (47%)
Blood Group O/non O41 (45%) / 49 (55%)40 (44%) / 50 (56%)
Cesarean sections / vaginal deliveries59 (65%) / 31 (35%)59 (65%) / 31 (35%)
PPH (number, percentage)33 (36,7%)10 (11,1%)
PPH among cesarean sections22 (37,3%)7 (11,9%)
PPH among vaginal deliveries11 (35,3%)3 (9,7%)

[Table 1. Study population – demographic, clinical and gynaecological characteristics]


[Figure n 1. Blood loss and platelet count at birth ]

To cite this abstract in AMA style:

Arcudi S, Ronchi A, Ossola MW, Iurlaro E, Capecchi M, Artoni A, Peyvandi F. Assessment of Post-partum Haemorrhage Risk among Women with Thrombocytopenia: A Cohort Study [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/assessment-of-post-partum-haemorrhage-risk-among-women-with-thrombocytopenia-a-cohort-study/. Accessed March 3, 2021.
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