Modern approaches for perinatal management in thrombocytopenia during pregnancy

The most common diseases of the blood system in pregnant women are anemia and thrombocytopenia (TP). There is a general tendency to significantly reducing of the number of platelets during pregnancy, starting from the first trimester with a minimum number of them during childbirth. Purpose — to learn the features of motion of pregnancy, diagnostic and curative tactician at the thrombocytopenia during pregnancy. The causes of TP during pregnancy are three groups of conditions — conditions for which TP is characteristic outside of pregnancy and conditions associated with pregnancy: gestational thrombocytopenia (GTP), pregnancy-specific complications, manifestations of diseases characterized by TP, with the chief reason among them — immune thrombocytopenia (ITP). The most common cause of TP during pregnancy is GTP, which, like ITP, is diagnose of exclusion that require differential diagnosis. The goal of treating TP during pregnancy is to achieve a safe platelet count that is different for each trimester, not target values. If the treatment of ITP is need lines of therapy with control of efficiency are consistently applied. Pregnant women with moderate and severe TP are a group of high perinatal risk, requiring careful differential diagnosis of the causes of TP, calculation of maternal and fetal risks, choice of tactics of such pregnancy, method and time of delivery, formation of postnatal care plan. No conflict of interest was declared by the authors. Key words: pregnancy, thrombocytopenia, immune thrombocytopenia, gestational thromocytopenia.

ANALYSIS OF THE PLATELET HEMOSTASIS AMONG PREGNANT WOMEN WITH IMMUNE THROMBOCYTOPENIA

Relevance: Thrombocytopenia is a common hematological problem that accompanies pregnancy. From 5% to 12% of pregnancies are complicated by thrombocytopenia. Gestational thrombocytopenia is the leading cause of complications (70-85%). Immune thrombocytopenia (ITP) is the most frequent reason among pre-pregnancy causes of thrombocytopenia and is responsible for 1-4% of all thrombocytopenia cases during pregnancy. Investigation of the functional potential of the thrombocyte link of hemostasis in conditions of a reduced number of thrombocytes is relevant. The purpose of the study was to analyze the platelet link of hemostasis in pregnant women with ITP of varying severity by the method of light aggregometry. Materials and Methods: Eighty-eight women with gestational and 28 with immune thrombocytopenia were undergoing treatment and delivery at the Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine (Kyiv, Ukraine) from September 2018 to February 2021. The platelet link of hemostasis was studied in a group of women with immune thrombocytopenia; six (21.4%) of them had severe thrombocytopenia. Results: In mild and moderate immune thrombocytopenia, we noted a decrease in spontaneous and induced platelet aggregation; in severe immune thrombocytopenia, there was no spontaneous and a decreased induced platelet aggregation. This indicated a reduced potential of platelets to perform their direct function – the formation of a thrombus. Conclusion: Immune thrombocytopenia accounts for most pre-pregnancy conditions causing thrombocytopenia in pregnant women. Light aggregometry is a relevant and indicative way to analyze the aggregative ability of platelets. A multidisciplinary team consisting of an obstetrician-gynecologist, hematologist, anesthesiologist, and neonatologist should be involved in the management of such cases to provide effective obstetric care for this category of pregnant women. Risks for the mother and the fetus/newborn should be assessed throughout the pregnancy, considering clinical and laboratory aspects. Delivery of pregnant women with severe thrombocytopenia should be managed at institutions providing the highest level of obstetric and gynecological care.

“MATERNAL OUTCOME IN PREGNANCY WITH THROMBOCYTOPENIA”

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.

Thrombocytopenia during pregnancy and its outcome- A prospective study

Thrombocytopenia is the second most common haematological finding in pregnancy after anaemia. Thrombocytopenia is defined as decrease in platelet count < 1,50,000/µL. The physiological thrombocytopenia of pregnancy is mild and has no adverse effects on mother and foetus whereas thrombocytopenia associated with medical conditions can have serious maternal-foetal consequences and needs specific monitoring and appropriate management. : The aims of the study were to evaluate causes of thrombocytopenia in pregnancy and to study clinical profile, maternal and perinatal outcome in thrombocytopenic antenatal patients after 28 weeks.: Aprospective study was conducted in department of Obstetrics and Gynaecology and department of Pathology at Government Medical College and Rajendra Hospital, Patiala.100 antenatal females were included in the study with platelet count <1,50,000/µL and period of gestation more than 28 weeks. The subjects were investigated after detailed history and examination. Maternal and foetal outcomes were observed in all cases.Out of 100 subjects with thrombocytopenia, 33% had gestational thrombocytopenia, which was the most common cause; followed by preeclampsia/eclampsia (24%). 18% subjects had severe thrombocytopenia. Complications were seen in the form of HELLP (6%), ICU admission (3%), PPH (3%), Puerperal sepsis (1%). Maternal thrombocytopenia due to medical causes needs strict observation and timely intervention for favourable maternal and perinatal outcomes.

Effect of Thrombocytopenia on Age and Method of Delivery among Pregnant Women in Late Trimester

Aim: To evaluate the effect of thrombocytopenia in pregnant women. Study design: Descriptive cross-sectional hospital based study Place and duration of study: Department of Obstetrics & Gynaecology, Liaquat University of Medical and Health Science Jamshoro from 1st June 2018 to 31st June 2019. Methodology: One hundred and seventy-six patients were observed. Women with pre-eclampsia, platelets less than 50X1010, singleton pregnancy and pregnancy greater than 32 weeks were included. Results: Most of the participants 91(51.9%) were 26 to 30 years with mean age was 30.71±4.45 years. Gestational duration in last trimester was 50(28.4%), 98(55.7%) and 28 (15.9%) of 28 to 32 Weeks, 32 to 36 Weeks and greater than 36 weeks respectively. Mean gestational duration was 35.11±2.3 Weeks. Seventy-one were falling in range of platelets of 30x1010 to 40x1010 (40.3%). Others were 46 (26.1%) of >40x1010, 43(24.4%) of 20x10-30x1010 and 16(9.1%) of 10x10-20x1010. One hundred and 41(80.1%) had vaginal deliveries and 35(19.9%) had lower segment caesarean section deliveries. Conclusion: The young participants of thrombocytopenia were more prevalent than old age participants. Keywords: Gestational thrombocytopenia, Platelet count, Pregnancy

Immune and Non-Immune Etiology of Thrombocytopenia: Neonatal and Maternal Causes

Neonatal thrombocytopenia (NT) is a common hemostatic abnormalitiy among newborn in the NICU, which increases with the degree of prematurity. It is well documented that this disease has a large range of feasible etiologies. Prematurity, early and late-onset sepsis and asphyxia are the most usual causes of NT. Moreover, FNAIT is the major risk for intracranial hemorrhage in the fetus or newborn. Here, we reviewed the causes for NT, in both newborns and mothers. We demonstrated the factors associated with NT in the newborn including placental insufficiency, fetal and neonatal alloimmune thrombocytopenia (FNAIT), prematurity, sepsis, and asphyxia. The causes of thrombocytopenia in pregnant women and its impact on newborns were also described. This review showed that gestational thrombocytopenia was the most common cause of thrombocytopenia with an incidence of 70-80%, followed by preeclampsia, HELLP and ITP. But neonates born to mothers with immune thrombocytopenia (ITP) had a higher risk for NT and hemorrhagic problems. In ITP, neonatal platelets are destroyed by maternal autoantibodies. We reviewed the causes of thrombocytopenia in neonates and mothers in two groups of immune and nonimmune factors. However, it seems that immunological factors are the most severe form of NT. However, it is necessary to separate NT etiology for differential diagnosis.