Category: Medical/Surgical/Diseases/Complications
Poster Session I
To investigate whether mild thrombocytopenia increases the risk of immediate postpartum hemorrhage (PPH) and blood transfusion compared with normal platelet levels.
Study Design: A retrospective cohort study of pregnant patients who delivered full-term singletons within a large health maintenance organization from 2008 to 2020 was performed. Maternal characteristics and outcomes of those with mild thrombocytopenia (platelet count 100-149k/mL) were compared to those with normal platelet levels (³150k/mL) prior to delivery. The primary outcome was the packed red blood cell (pRBC) transfusion, as it is a more rare, but clinically relevant outcome. Secondary outcomes included quantity of pRBC transfused, PPH (blood loss ³1,000mL), additional procedures performed (peripartum hysterectomy, dilation and curettage, uterine artery embolization), use of uterotonic medications, hospital length of stay, and ICU admission. Statistical analysis was done using Chi-square or Kruskal-Wallis analysis as appropriate. A multivariate logistic regression was also performed to adjust for potential confounders.
Results: A total of 305,794 pregnant individuals were included in this study. Mild thrombocytopenia prior to delivery was associated with a small but statistically significant increased rate of postpartum pRBC transfusion compared to normal platelet levels (1.2% vs 0.9%, p< 0.0001). Mild thrombocytopenia was also associated with a higher rate of two or more pRBCs transfused (27.6% vs 22.5%), PPH (2.4% vs 2.0%), use of uterotonics, and needing additional procedures performed compared to normal platelet levels (all p-values < 0.03) (Table 1). These outcomes all remained statistically significant after adjusting for confounding variables (Table 2).
Conclusion: Mild thrombocytopenia is associated with an increased risk of pRBC transfusion, PPH, uterotonic use, and need for additional procedures postpartum. Identifying pregnant individuals at increased risk for PPH is important for advanced planning and increased surveillance after delivery to prevent adverse outcomes.
Rebecca J. Post, MD (she/her/hers)
Maternal Fetal Medicine Physician
University of California, Irvine
Orange, California, United States
Adrian L. Hernandez Lopez, MD (he/him/his)
Maternal Fetal Medicine Fellow
University of California, San Francisco
San Francisco, California, United States
Adam Crosland, MD,MPH
Maternal Fetal Medicine Physician
Oregon Health and Science University Hospital
Long Beach, California, United States
Joanie Chung, MPH
Kaiser Permanente Research
Pasadena, California, United States
Judith H. Chung, MD, PhD
Professor of Clinical Obstetrics and Gynecology
UC Irvine Health
Orange, California, United States
Richard Benoit, MD, MPH
Kaiser Los Angeles Medical Center
Los Angeles, California, United States