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]
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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