scholarly journals Study of thrombocytopenia in pregnancy: clinical presentation and outcome at tertiary care rural institute

2020 ◽  
Vol 9 (4) ◽  
pp. 1622
Author(s):  
Jigyasa Singh ◽  
Kalpana Kumari ◽  
Vandana Verma
Keyword(s):  
Platelet Count ◽  
Prospective Observational Study ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
Late Pregnancy ◽  
Normal Platelet ◽  
Gestational Thrombocytopenia ◽  
Underlying Causes ◽  
In Pregnancy ◽  
Rule Out

Background: Platelet count below 1.5 lakh/cumm is called as thrombocytopenia. After anaemia it is the second most common haematological disorder in pregnancy. It affects nearly 6 to 15%; on an average 10% of all pregnancies. Gestational thrombocytopenia is a clinically benign thrombocytopenic disorder usually occurring in late pregnancy. It resolves spontaneously after delivery.Methods: It is a hospital based prospective observational study over a period of 1 year. All pregnant women who attended OPD at the department of obstetrics and gynecology, UPUMS, Saifai for antenatal checkup were included for the study and blood sample was withdrawn.Results: Out of 263 cases enrolled for study, 90 women were found to have thrombocytopenia, and 173 had normal platelet count. Thus, incidence of thrombocytopenia was 34%. Gestational thrombocytopenia accounted for majority of cases of thrombocytopenia in pregnancy (50%) followed by hypertensive disorders (22.4%). It was further followed by ITP (11.11%) and dengue (5.5%).Conclusions: Gestational thrombocytopenia is the most common cause of thrombocytopenia during pregnancy (50%), but other underlying causes must be considered as well. A thorough history and physical examination will rule out most causes.

scholarly journals Pregnancy emerged thrombocytopenia: maternal and fetal outcome

2020 ◽  
Vol 8 (10) ◽  
pp. 3554
Author(s):  
Fasiha Tasneem ◽  
Vinutha M. Sharma
Keyword(s):  
Platelet Count ◽  
Incidental Finding ◽  
Multiorgan Failure ◽  
Tertiary Care ◽  
Fetal Outcome ◽  
Gestational Thrombocytopenia ◽  
Elevated Liver Enzymes ◽  
Low Platelet Count ◽  
Ceserean Section ◽  
In Pregnancy

Background: A low platelet count is often an incidental finding in pregnancy. It can be an indicator of a severe systemic disorder requiring emergent maternal and fetal care or can just be unique to pregnancy with no harm to mother or fetus. Physiological decrease in platelet count is seen in pregnancy due to hemodilution and hypercoagulating state, though the exact pathophysiology is still unclear.Methods: It is a prospective observational study done in a tertiary care centre.Results: In about 11,258 cases screened 46 patients had thrombocytopenia (0.4%). The commonest etiology is found to be gestational thrombocytopenia (n=21, 45.6%) followed by preeclampsia/ eclampsia/ HELLP (haemolysis, elevated liver enzymes, low platelet count) syndrome (n=19, 41.3%). Only one patient had immune thrombocytopenic purpura (ITP) and 7 (15.3%) were associated with amplified fragment length polymorphism (AFLP). Maximum of them (n=19, 41.3%) underwent spontaneous vaginal delivery. 4 patients (8.6%) had postpartum haemorrhage, 6 (13.04%) had ceserean section wound infection, 4 (8.6%) had disseminated intravascular coagulation (DIC) and 4 (8.6%) had multiorgan failure. 13 patients (28.3%) had platelet count between 40 to 60 thousand per cumm, 11 (23.9%) had between 60 to 80 thousand per cumm, 10 (21.7%) had between 80,000 to 1 lakh and none had their platelet count less than 20,000 per cumm.Conclusions: Gestational thrombocytopenia is not a preventable condition. It is an incidental finding in pregnancy. With strict vigilance during intrapartum and postpartum period, even without any treatment proper for the same, the maternal and fetal outcome is found to be good.

scholarly journals Immune Thrombocytopenic Purpura in Pregnancy- A Prospective Observational Study in a Tertiary Care Centre

2019 ◽  
Vol 34 (1) ◽  
pp. 15-21
Author(s):  
Tabassum Parveen ◽  
Firoza Begum ◽  
Nahreen Akhter ◽  
Nigar Sultana ◽  
Khairun Nahar
Keyword(s):  
Platelet Count ◽  
High Risk ◽  
Observational Study ◽  
Immune Thrombocytopenic Purpura ◽  
Platelet Transfusion ◽  
Prospective Observational Study ◽  
Thrombocytopenic Purpura ◽  
Neonatal Thrombocytopenia ◽  
Itp In Pregnancy ◽  
In Pregnancy

Objectives: Immune thrombocytopenic purpura (ITP) in pregnancy necessitates management of two patients, the mother and the newborn. Complications like maternal bleeding, fetal and neonatal thrombocytopenia demands appropriate and timely therapy. This prospective observational study was designed to explore and summarize the current approach to the investigation, diagnosis, management and outcome of ITP in pregnancy. Materials and Methods: Women with ITP admitted in the Fetomaternal Medicine Department of Bangabandhu Sheikh Mujib Medical University (BSMMU) from 2009 -2017, were included in the study. Total number of high risk pregnancy during that period were 7704 among them 20 cases were pregnancy with Immune Thrombocytopenic Purpura (ITP). Patients were managed under joint supervision of the fetomaternal medicine specialist and the hematologist. Prednisolone was considered as a first line drug in management protocol. Platelet transfusion was considered if there were symptoms or count <20X109/L at any stage of pregnancy or <50 X109 / L in late pregnancy without symptoms. Platelet count of newborn was performed at birth and repeated on day four and count<150X109/L was considered as neonatal thrombocytopenia. Results: Frequency of ITP among high risk patients was found 2.5/1000 live birth, most were preexisting (75%). Almost all cases (95%) were treated with prednisolone. Commonest clinical presentations were gum bleeding (70 %) and purpuric rashes (60%). Though during pregnancy, severe thrombocytopenia (<50 X109/L) was found in 7 patients (35%) but none was at the time of delivery, as drugs and/or platelet transfusion was considered to make delivery process safe. Platelet transfusion needed in 77.7% cases in a range of 1-75 units. Primary PPH noted in 3 cases (17%), increased bleeding during surgery in 5 patients (33%) and one patient needed ICU support. Neonatal thrombocytopenia noted in 5 cases (28%). Though 2 of the neonates needed NICU admission but none needed platelet transfusion and all the babies were discharged healthy. Conclusion: This study documents that pregnancy with ITP need close monitoring, require agents to raise the platelet count and repeated platelet transfusion to maintain reasonable safe platelet count. There are chances of PPH, capillary oozing during surgery. However good outcome is possible for most women, fetus and neonates with appropriate and timely therapy. Bangladesh J Obstet Gynaecol, 2019; Vol. 34(1): 15-21

“MATERNAL OUTCOME IN PREGNANCY WITH THROMBOCYTOPENIA”

2021 ◽  
pp. 12-15
Author(s):  
Uma Jain ◽  
Preeti Gupta ◽  
Deepali Jain
Keyword(s):  
Platelet Count ◽  
Platelet Transfusion ◽  
Normal Pregnancy ◽  
Maternity Hospital ◽  
Severe Thrombocytopenia ◽  
Fetal Outcomes ◽  
Puerperal Sepsis ◽  
Frequent Monitoring ◽  
Gestational Thrombocytopenia ◽  
In Pregnancy

INTRODUCTIONThrombocytopenia is diagnosed when the platelet count is less than 1,50,000 per microliter of blood It is a common hematological disorder Thrombocytopenia is divided into 3 types according to severity: mild (100,000 to 150,000), moderate (50,000to100,000) and severe (less than 50,000) thrombocytopenia. MATERIALAND METHODObjective- To study the incidence of thrombocytopenia in normal pregnancy. to study the maternal and fetal outcomes in pregnant patients with thrombocytopenia This is a retrospective study in which a total of 1202 patients delivered in a maternity hospital of Gwalior from 1 January 2018 to 30 June 2019 were studied. 72 patients with a platelet count below 1.5 lakhs were included in the study. RESULTSA total of 1202 patients were delivered during the study period out of the 72 patient had thrombocytopenia thus the prevalence was found to be 5.99%. rd In our study majority of the patients were multigravida 63.88% in the 3 trimester 54.16% majority by between age of 25-30 years 58.33%. In our study 61.11% of women had mild, 27.77 had moderate and 11.11% had severe thrombocytopenia. In this study, gestational thrombocytopenia was the most common etiological factor with 29.16% of cases. In our study, 70.83% of patients were delivered vaginally and 29.16% of patients were delivered by LSCS. No complication was reported in 48.61% of patients. The bleeding during CS was found in 4.16% cases, maternal hemorrhage was found in 5.55%, pulmonary edema in 5.55%, ARF in 5.55%, DIC 4.16%, and Puerperal sepsis in 2.77%. Blood transfusion was needed in 15.27% of patients, platelet transfusion in 4.16% of patients. Obstetric hysterectomy was done in 1 patient. During the study, 2 maternal death were reported due to the HELLPsyndrome and associated complications. CONCLUSIONGestational thrombocytopenia is the most common cause of thrombocytopenia during pregnancy. We conclude that early diagnosis of thrombocytopenia in pregnancy is essential for better maternal and fetal outcomes. It is important to determine the exact etiological cause of thrombocytopenia so that timely management can be provided to the pregnant patients to decrease the complication rate thus, timely diagnosis, frequent monitoring, and treatment is must achieve a better outcome.

scholarly journals Effects of thrombocytopenia in pregnancy

2018 ◽  
Vol 7 (3) ◽  
pp. 1044 ◽  
Author(s):  
Shital N. Kapadia ◽  
Harsh S. Patel ◽  
Kartikey G. Parmar
Keyword(s):  
Platelet Count ◽  
Retrospective Study ◽  
Gestational Age ◽  
Antenatal Visit ◽  
Civil Hospital ◽  
Multiple Factors ◽  
Gestational Thrombocytopenia ◽  
Common Etiology ◽  
One Year ◽  
In Pregnancy

Background: Thrombocytopenia defined as platelet count of less than 1,50,000/cu.mm. Thrombocytopenia is divided according to severity into mild moderate and severe types. Multiple factors are responsible.Methods: This is a retrospective study of one-year period including 120 pregnant patients irrespective of their gestational age at civil hospital Ahmedabad. Etiology of this condition are identified and analyzed.Results: Gestational Thrombocytopenia is the most common etiology. This condition is self-limiting usually.Conclusions: Platelet count estimation should be a routine at first antenatal visit for timely diagnosis and to achieve favorable fetomaternal outcome. 

scholarly journals Platelet count estimation: a prognostic index in pregnancy induced hypertension

2018 ◽  
Vol 7 (2) ◽  
pp. 476
Author(s):  
Aakriti Gupta ◽  
Jyoti Hak ◽  
Isha Sunil ◽  
Amita Gupta
Keyword(s):  
Platelet Count ◽  
Pregnant Women ◽  
Prognostic Index ◽  
Disease Process ◽  
Late Pregnancy ◽  
Control Group ◽  
The Mean ◽  
The Difference ◽  
And Control ◽  
In Pregnancy

Background: Hypertension in pregnancy is one of the serious complications of pregnancy with an incidence of 5% to 7% of all pregnancies, particularly in cases with preeclampsia and eclampsia. Though platelet count during pregnancy is within the normal non pregnant reference values, there is a tendency for the platelet count to fall in late pregnancy. The frequency and intensity of maternal thrombocytopenia varies and is dependent on the intensity of the disease process and duration of PIH syndrome.Methods: A prospective observational study was conducted on 200 pregnant women attending OPD Or Inpatients in the Department of Obstetrics and Gynecology, SMGS Hospital, GMC Jammu from November 2015 to October 2016. Pregnant women beyond 28 weeks gestation of pregnancy are included and divided into two groups i.e. the study and control group. Platelet counts will be done every 4 weeks in controls and weekly in subjects from 28 weeks till delivery.Results: The mean platelet count observed among cases of mild preecclampsia, severe preeclampsia and ecclampsia was 2.26, 1.63 and 0.99 lakh/mm3 respectively. The difference in mean platelet count among cases and controls was statistically significant. The association of platelet count with severity of different categories of PIH was analysed statistically and was highly significant.Conclusions: Platelet count is a very important investigation for the antenatal mother having PIH, as it is directly related to maternal and perinatal outcome. Routine and regular monitoring of platelet count can be included in the routine antenatal checkup among the pregnant women with PIH.

Thrombocytopenia in Pregnancy: Approach to Diagnosis and Management

2020 ◽  
Vol 46 (03) ◽  
pp. 256-263
Author(s):  
Annemarie E. Fogerty
Keyword(s):  
Platelet Count ◽  
Immune Thrombocytopenia ◽  
Thrombocytopenic Purpura ◽  
Gestational Thrombocytopenia ◽  
Life Threatening ◽  
Immune Thrombocytopenia Purpura ◽  
The Impact ◽  
Underlying Pathophysiology ◽  
In Pregnancy ◽  
Management Issues

AbstractThe impact of thrombocytopenia varies widely depending on the underlying pathophysiology driving it. The biggest challenge in managing thrombocytopenia in pregnancy is accurately identifying the responsible pathophysiology—a task made difficult given the tremendous overlap in clinical and laboratory abnormalities associated with different thrombocytopenia processes. The most common etiologies of thrombocytopenia in pregnancy range from physiology deemed benign to those that are life-threatening to the mother and fetus. Even in cases in which the responsible etiology is deemed benign, such as gestational thrombocytopenia, there are still implications for the management of labor and delivery, a time where hemostatic challenges may prove life-threatening. In most institutions, a minimum platelet count will be mandated for epidural anesthesia to be deemed a safe option. The causes of thrombocytopenia can also include diagnoses that are pregnancy-specific (such as preeclampsia or gestational thrombocytopenia), potentially triggered by pregnancy (such as thrombotic thrombocytopenic purpura), or unrelated to or predating the pregnancy (such as liver disease, infections, or immune thrombocytopenia purpura). It is imperative that the source of thrombocytopenia is identified accurately and expeditiously, as intervention can range from observation alone to urgent fetal delivery. In this review, the approach to diagnosis and the pathophysiological mechanisms of the most common etiologies of thrombocytopenia in pregnancy and associated management issues are presented.

scholarly journals Low platelet counts in pregnancy: an alarm signal for abruption!

2018 ◽  
Vol 7 (3) ◽  
pp. 1191 ◽  
Author(s):  
Anjali Mundkur ◽  
K. P. Murali Krishnan Nambiar ◽  
Lavanya Rai
Keyword(s):  
Platelet Count ◽  
Pregnant Women ◽  
Connective Tissue Disorder ◽  
Severe Thrombocytopenia ◽  
Related Condition ◽  
Alarm Signal ◽  
Hematologic Disorder ◽  
Gestational Thrombocytopenia ◽  
In Pregnancy ◽  
Do So

Background: Thrombocytopenia, defined as a platelet count less than 150 million/mm3, affects 6% to 10% of all pregnant women and other than anemia is the most common hematologic disorder in pregnancy.Methods: We studied all patients with thrombocytopenia in pregnancy from June 2012 to May 2013. There were 86 patients recruited into the study. Pregnant women with preeclampsia and suspected connective tissue disorder were also screened for thrombocytopenia. All women with platelet count of <1.50,000/µl during the study period were included.Results: Patients were grouped in to mild thrombocytopenia (platelet 100,000-149,999/µl), moderate thrombocytopenia (platelet 50,000-99,999/µl) and severe thrombocytopenia (platelet <49,999/µl. Pregnancy specific cause of thrombocytopenia was in 63 (73.2%) women and non-pregnancy specific were in 23(26.7%) patients.Conclusions: Preeclampsia and HELLP syndrome is more common cause of thrombocytopenia in pregnancy. Abruption can occur in patients with severe thrombocytopenia. Though platelet count is not routinely done in pregnancy it is advisable to do so as it may help in detecting gestational thrombocytopenia or other immune related condition.

scholarly journals Pattern of clinical and hematological profile in patients diagnosed as megaloblastic anemia in a tertiary care centre

2019 ◽  
Vol 26 (06) ◽  
Author(s):  
Muhammad Ihtesham Khan ◽  
Asif Hussain Munir ◽  
Syeda Hina Fatima
Keyword(s):  
Bone Marrow ◽  
Platelet Count ◽  
Clinical Presentation ◽  
Megaloblastic Anemia ◽  
Tertiary Care ◽  
Clinical Feature ◽  
Physical Sign ◽  
Female Ratio ◽  
Pathology Department ◽  
Cell Counts

Objectives: To determine the pattern of clinical presentation, pattern of cytopenias, and haematological parameters of megaloblastic anemia in our setup. Study Design: Cross Sectional Descriptive study. Setting: Pathology Department, Khyber Teaching Hospital, Peshawar. Duration: January 2016 to December 2016 (one year period). Material and Methods: A total of 337 patients underwent bone marrow biopsy during the study period, out of which 46 patients were diagnosed as having megaloblastic anemia on bone marrow aspirate and B12 levels. The clinical features and hematological parameters of these patients were recorded in a proforma and the results were drawn accordingly. All cell counts were done on automated counter machine. Results: Out of 337 patients referred to pathology department for bone marrow aspiration, about 45 cases had megaloblastic anemia. These 45 cases were included in the study. Age of the study sample ranged from 1 year to 90 years (mean 32.2 years ± 12.1 SD). There were 35 (78%) males and 10 (22%) females, with male to female ratio of 3.5:1. Commonest clinical feature was generalized weakness and loose motion, while commonest physical sign was pallor, which were seen in 36 (80%), 36 (80%) and 40 (88%) cases respectively. About 28 (62%) patients had pancytopenia, 9 (20%) patients had bicytopenia (low hemoglobin and platelet count), and 8 (18%) cases had isolated anemia. Low Hb was present in all the 45 (100%) patients. Both the mean hemoglobin level and platelet count were reduced (7.4g/dL and 128x109/L. respectively) while mean white cell count in study sample was normal (mean 5.0x109/L). Conclusion: Megaloblastic anemia may presents as anemia, bicytopenia or pancytopenia. The cytopenias are important feature of megaloblastic anemia. Generalized weakness, and lethargy are the common clinical presentation, while pallor is common physical finding. Patients presenting with a constellation of generalized weakness, pallor and pancytopenia should be suspected of megaloblastic anemia and should be investigated accordingly.

scholarly journals Placenta in pregnancy induced hypertension

2018 ◽  
Vol 7 (2) ◽  
pp. 467
Author(s):  
Pooja Kashinath Bandekar ◽  
Prashant Bhimrao Kale
Keyword(s):  
Clinical Presentation ◽  
Histopathological Examination ◽  
Tertiary Care ◽  
Cumulative Effects ◽  
Important Predictor ◽  
Pregnancy Induced Hypertension ◽  
Intrauterine Environment ◽  
Induced Hypertension ◽  
In Pregnancy

Background: Placenta is a predictor of outcome of pregnancy. Placental examination holds an important role in improving outcome of pregnancy. It is strategically located at feto-maternal interface and it acts like a record of pregnancy in which the cumulative effects of pregnancy related events and changes reflecting the intrauterine environment can be scrutinized. Objective of present study was to diagnose presence, if at all, of lesions of placenta and their nature in cases of pregnancy induced hypertension specifically in 2nd and 3rd trimester of pregnancy and to classify the lesions based on clinical presentation and to compare the results.Methods: This study is based on histopathological examination of placenta in cases of PIH over a period of three years, from May 2011 to April 2014. The study was carried out at a tertiary care hospital.Results: There were 280 (19.4%) cases of PIH amongst a total of 1440 cases. In these 280, 170 (60.72%) cases had severe PIH, 110 (39.28%) cases had mild PIH. Also, 180 (16.28%) cases revealed increased morbidity and mortality.Conclusions: Evaluation of placenta is an extremely important predictor, that helps to improve the outcome of pregnancy.

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