Patterns and Implications of Thrombocytopenia In Pregnant Women

Thrombocytopenia--defined by a decreased platelet count--is a hematological condition that can arise during pregnancy. The physiological changes of pregnancy, in conjunction with underlying medical conditions, contribute to its complexity - affecting both maternal and fetal health.

A recent prospective observational study conducted at Saveetha Medical College between 2022 and 2023 involved pregnant women aged 18-40 years. Participants underwent routine blood tests that evaluated platelet counts, with additional data collected on demographics, medical history, and lifestyle factors. Maternal and fetal outcomes were monitored; the statistical analyses included descriptive and regression methods.

Out of the 1,980 deliveries, 88 cases (4.4%) were diagnosed with thrombocytopenia. The causes included gestational thrombocytopenia (42%), dengue (32%), severe pre-eclampsia (11%), eclampsia (6%), immune thrombocytopenia (4%), scrub typhus (2%), HELLP syndrome (2%), and partial HELLP syndrome (1%). Diagnoses predominantly occurred in the third trimester (77%), with thrombocytopenia classified as mild (69%), moderate (30%), and severe (1%). Primiparous women were more likely to experience severe thrombocytopenia (p=0.03). Meanwhile, fetal outcomes varied by etiology, with 9% showing fetal growth restriction, 4% neonatal thrombocytopenia, 3% birth asphyxia, and 2% intrauterine death.

The findings underscored the diverse causes and implications of thrombocytopenia during pregnancy - with gestational thrombocytopenia emerging as the most common and generally benign condition. The study emphasized the importance of vigilant monitoring, particularly in the third trimester. The authors advocated the need for individualized care and follow-up for affected neonates. 

These insights contribute to improved prenatal care practices and provide a foundation for future research to refine diagnostic and therapeutic approaches for managing thrombocytopenia in pregnancy.

Source: Mathesan M, Ethirajan S. Exploring the patterns of thrombocytopenia in pregnancy: unravelling implications and outcomes. Indian J Obstet Gynecol Res. 2024;11(4):534-539