Mild thrombocytopenia indicating maternal organ damage in pre‐eclampsia: a cross‐sectional study

Abstract Background Currently, there is a disagreement between guidelines regarding platelet count cut-off values as a sign of maternal organ damage in pre-eclampsia; the American College of Obstetricians and Gynecologists guidelines state a cut-off value of < 100 × 109/L; however, the International Society for the Study of Hypertension in Pregnancy guidelines specify a cut-off of < 150 × 109/L. We evaluated the effect of mild thrombocytopenia: platelet count < 150 × 109/L and ≥ 100 × 109/L on clinical features of pre-eclampsia to examine whether mild thrombocytopenia reflects maternal organ damage in pre-eclampsia. Methods A total of 264 women were enrolled in this study. Participants were divided into three groups based on platelet count levels at delivery: normal, ≥ 150 × 109/L; mild thrombocytopenia, < 150 × 109/L and ≥ 100 × 109/L; and severe thrombocytopenia, < 100 × 109/L. Risk of severe hypertension, utero-placental dysfunction, maternal organ damage, preterm delivery, and neonatal intensive care unit admission were analyzed based on platelet count levels. Estimated relative risk was calculated with a Poisson regression analysis with a robust error. Results Platelet counts indicated normal levels in 189 patients, mild thrombocytopenia in 51 patients, and severe thrombocytopenia in 24 patients. The estimated relative risks of severe thrombocytopenia were 4.46 [95 % confidence interval, 2.59–7.68] for maternal organ damage except for thrombocytopenia, 1.61 [1.06–2.45] for preterm delivery < 34 gestational weeks, and 1.35 [1.06–1.73] for neonatal intensive care unit admission. On the other hand, the estimated relative risks of mild thrombocytopenia were 0.97 [0.41–2.26] for maternal organ damage except for thrombocytopenia, 0.91 [0.62–1.35] for preterm delivery < 34 gestational weeks, and 0.97 [0.76–1.24] for neonatal intensive care unit admission. Conclusions Mild thrombocytopenia was not associated with severe features of pre-eclampsia and would not be suitable as a sign of maternal organ damage.

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Mild thrombocytopenia indicating maternal organ damage in pre-eclampsia: a cross-sectional study

10.21203/rs.3.rs-103716/v1 ◽

2020 ◽

Author(s):

Michinori Mayama ◽

Mamoru Morikawa ◽

Takashi Yamada ◽

Takeshi Umazume ◽

Kiwamu Noshiro ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Platelet Count ◽

Intensive Care Unit Admission ◽

Neonatal Intensive Care Unit ◽

Preterm Delivery ◽

Neonatal Intensive Care ◽

Organ Damage ◽

Severe Thrombocytopenia ◽

Adjusted Risk

Abstract BackgroundCurrently, there is a disagreement between guidelines regarding platelet count cut-off values as a sign of maternal organ damage in pre-eclampsia; the American College of Obstetricians and Gynecologists guidelines state a cut-off value of <100× 109/L; however, the International Society for the Study of Hypertension in Pregnancy guidelines specify a cut-off of <150 × 109/L. We evaluated the effect of mild thrombocytopenia: platelet count <150 × 109/L and ≥100 × 109/L on clinical features of pre-eclampsia to examine whether mild thrombocytopenia reflects maternal organ damage in pre-eclampsia. MethodsA total of 264 women were enrolled in this study. Participants were divided into three groups based on platelet count levels at delivery: normal, ≥150 × 109/L; mild thrombocytopenia, <150 × 109/L and ≥100 × 109/L; and severe thrombocytopenia, <100 × 109/L. Risk of severe hypertension, utero-placental dysfunction, maternal organ damage, preterm delivery, and neonatal intensive care unit admission were analyzed based on platelet count levels. Adjusted relative risk were calculated with a Poisson regression analysis with a robust error. ResultsPlatelet counts indicated normal levels in 189 patients, mild thrombocytopenia in 51 patients, and severe thrombocytopenia in 24 patients. The adjusted risk ratios of severe thrombocytopenia were 2.11 [95% confidence interval, 1.61–2.77] for maternal organ damage except thrombocytopenia, 1.24 [1.01–1.53] for preterm delivery <34 gestational weeks, and 1.16 [1.02–1.32] for neonatal intensive care unit admission. On the other hand, the adjusted risk ratios of mild thrombocytopenia were 1.06 [0.86–1.30] for severe hypertension, 1.17 [0.74–1.83] for utero-placental dysfunction, 0.96 [0.41–2.24] for maternal organ damage except thrombocytopenia, 0.89 [0.60–1.31] for preterm delivery <34 gestational weeks, and 0.96 [0.75–1.23] for neonatal intensive care unit admission. ConclusionsMild thrombocytopenia was not related with severe features of pre-eclampsia and would not be suitable as a sign of maternal organ damage.

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Obstetric Outcomes in Singleton Pregnancies with Abnormal Placental Cord Insertions

American Journal of Perinatology ◽

10.1055/s-0041-1729163 ◽

2021 ◽

Author(s):

Leilah D. Zahedi-Spung ◽

Molly J. Stout ◽

Ebony B. Carter ◽

Jeffrey M. Dicke ◽

Methodius G. Tuuli ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Neonatal Intensive Care Unit ◽

Cesarean Delivery ◽

Preterm Delivery ◽

Gestational Age ◽

Apgar Score ◽

Neonatal Intensive Care ◽

Increased Risk

Objective There is wide variation in the management of pregnancies complicated by abnormal placental cord insertion (PCI), which includes velamentous cord insertion (VCI) and marginal cord insertion (MCI). We tested the hypothesis that abnormal PCI is associated with small for gestational age (SGA) infants. Study Design This is a retrospective cohort study of all pregnant patients undergoing anatomic ultrasound at a single institution from 2010 to 2017. Patients with abnormal PCI were matched in a 1:2 ratio by race, parity, gestational age at the time of ultrasound, and obesity to patients with normal PCIs. The primary outcome was SGA at delivery. Secondary outcomes were cesarean delivery, preterm delivery, cesarean delivery for nonreassuring fetal status, 5-minute Apgar score < 7, umbilical artery pH < 7.1, and neonatal intensive care unit admission. These outcomes were compared using univariate and bivariate analyses. Results Abnormal PCI was associated with an increased risk of SGA (relative risk [RR]: 2.43; 95% confidence interval [CI]: 1.26–4.69), increased risk of preterm delivery <37 weeks (RR: 3.60; 95% CI: 1.74–7.46), and <34 weeks (RR: 3.50; 95% CI: 1.05–11.63) compared with patients with normal PCI. There was no difference in rates of cesarean delivery, Apgar score of <7 at 5 minutes, acidemia, or neonatal intensive care unit admission between normal and abnormal PCI groups. In a stratified analysis, the association between abnormal PCI and SGA did not differ by the type of abnormal PCI (p for interaction = 0.46). Conclusion Abnormal PCI is associated with an increased risk of SGA and preterm delivery. These results suggest that serial fetal growth assessments in this population may be warranted. Key Points

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Faculty Opinions recommendation of [Examination of maternal extended spectrum beta-lactamase bacterial colonization and follow-up of newborns requiring Neonatal Intensive Care Unit admission].

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727797260.793534178 ◽

2017 ◽

Author(s):

Jean-Ralph Zahar

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Bacterial Colonization ◽

Beta Lactamase ◽

Extended Spectrum Beta Lactamase ◽

Extended Spectrum

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Invasive antenatal procedures and requirement for neonatal intensive care unit admission

European Journal of Pediatrics ◽

10.1007/s004310050660 ◽

1997 ◽

Vol 156 (7) ◽

pp. 550-552 ◽

Cited By ~ 8

Author(s):

A. Greenough ◽

B. Yuksel ◽

S. Naik ◽

P. Cheeseman ◽

K. H. Nicolaides

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care

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Confounders for Neonatal Intensive Care Unit Admission ın Neonates of Mothers with Preeclampsia

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2018.804 ◽

2018 ◽

Vol 24 (3) ◽

pp. 162

Author(s):

Cetin Kilicci ◽

Cigdem Yayla Abide ◽

Enis Ozkaya ◽

Evrim Bostancı Ergen ◽

İlter Yenidede ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Birth Weight ◽

Intensive Care Unit Admission ◽

Neonatal Intensive Care Unit ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Preterm Neonates ◽

Apgar Scores ◽

Gestational Age At Delivery

Objective: The aim of this study was to investigate the effect of some maternal and neonatal clinical parameters on the neonatal intensive care unit admission rates of neonates born to mothers who had preeclampsia. Study Design: Study included 402 singleton pregnant women with preeclampsia who admitted to Maternal-Fetal Medicine Unit of Zeynep Kamil Children and Women’s Health Training and Research Hospital. Pregnancies with uterine rupture, chorioamnionitis and congenital malformations were excluded. Some maternal and neonatal clinical characteristics were assessed to predict neonatal intensive care unit admission.Results: Among 402 neonates, 140 (35%) of them had an indication for neonatal intensive care unit admission, among 140 neonates, 136 (97%) of them were preterm neonates. Comparison of groups with and without neonatal intensive care unit admission indicated significant differences between groups in terms of gestational age, Apgar scores at 1st and 5th minutes, birth weight, some maternal laboratory parameters (Hemoglobin, hematocrit, alanine aminotransferase, aspartate aminotransferase, albumin). In multivariate analysis, among all study population, gestational age at delivery, birth weight and Apgar scores were found to be significantly associated with neonatal intensive care unit admission. On the other hand, in subgroup of term neonates, none of the variables was shown to be associated with neonatal intensive care unit admission.Conclusion: Gestational age at delivery and the birth weight are the main risk factors for neonatal intensive care unit admission of neonates born to mothers who had preeclampsia.

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