Abstract Number: PB2561
Meeting: ISTH 2020 Congress
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/mcl | Platelet 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) |
| Caucasian | 73 (81%) | 72 (79,9%) |
| Nulliparous | 56 (62%) | 43 (47%) |
| Blood Group O/non O | 41 (45%) / 49 (55%) | 40 (44%) / 50 (56%) |
| Cesarean sections / vaginal deliveries | 59 (65%) / 31 (35%) | 59 (65%) / 31 (35%) |
| PPH (number, percentage) | 33 (36,7%) | 10 (11,1%) |
| PPH among cesarean sections | 22 (37,3%) | 7 (11,9%) |
| PPH among vaginal deliveries | 11 (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.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/assessment-of-post-partum-haemorrhage-risk-among-women-with-thrombocytopenia-a-cohort-study/