Aetiology and Outcomes of Thrombocytopenia in Pregnancy: A Cross-Sectional Study in a University Hospital, India

Abstract

Background: Thrombocytopenia (TCP) is the second most common haematological finding in pregnancy next to anaemia. It carries a risk for both the mother and the fetus, associated with substantial maternal or neonatal morbidity and mortality. However, a specific therapy, if instituted promptly, improves the outcome for affected patients and their offspring. In patients in India, TCP during pregnancy is an underexplored condition. Objectives: To assess the aetiology of TCP in pregnancy and to assess the maternal outcomes of TCP in pregnancy. Methodology: The authors included a total of 133 patients in their third trimester (>32 weeks), with a platelet count less than 149,000 /mm3, admitted to the authors’ institution from 1st January 2021 to 31st December 2021. Patient-related data such as menstrual and obstetric history, presenting complaints, obstetric examination, and basic investigations were collected in a pre-designed, pre-tested proforma. All cases were followed until delivery to record any maternal complications, or any other morbidities. The data were analysed using SPSS (International Business Machines Corporation, Armonk, New York, USA) software. χ2 test was used to compare the proportions between the groups. p less than 0.05 was considered significant. Results: Overall, 64.7 percent of patients were in the 18–25 years age group and 49.6 percent of patients were primigravida. Furthermore, 60.9 percent of patients were diagnosed to have mild TCP, 32.3 percent had moderate TCP, and only 6.8 percent patients had severe TCP. The majority (75.2%) of cases were of gestational TCP. In total, 15.8% of cases had pregnancy-induced hypertension (PIH); 3.0 percent had dengue; 2.3 percent were COVID-19 positive; 1.5 percent were diagnosed with haemolysis, elevated liver enzymes, and low platelets syndrome; 1.5 percent had immune TCP; and only one patient had leptospirosis. Four percent of cases had gestational TCP, 9.5% had PIH, one patient (25.0%) had dengue, and both cases of immune TCP had severe TCP. Twenty-eight percent of gestational TCP cases; 47.6 percent of PIH cases, both cases of haemolysis, elevated liver enzymes, and low platelets syndrome; 50.0 percent of dengue cases; and one COVID-19 positive case (33.0%) had moderate TCP. Finally, 6.25% of patients who underwent lower segment caesarean section had severe TCP, 6.00% of patients who underwent vaginal delivery had severe TCP, and out of two patients who had a spontaneous abortion, one (50.00%) had severe TCP at the time of admission. The association was significant (p less than 0.05). Conclusion: TCP is a crucial condition among pregnant patients. Mild TCP is a common type. Correct aetiological diagnosis, and promptly administered adequate and specific therapy are, therefore, essential to significantly improve the outcomes of pregnant patients and their offspring.