Am J Perinatol 2017; 34(11): 1135-1141
DOI: 10.1055/s-0037-1604194
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

How Low Is Too Low? Postpartum Hemorrhage Risk among Women with Thrombocytopenia

Laura M. Carlson
1  Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
,
Sarah K. Dotters-Katz
1  Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
,
Marcela C. Smid
1  Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
2  Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
,
Tracy A. Manuck
1  Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
› Author Affiliations
Further Information

Publication History

02 June 2017

08 June 2017

Publication Date:
06 July 2017 (eFirst)

Abstract

Objective To estimate the association between severity of thrombocytopenia and postpartum hemorrhage.

Study Design We performed a secondary analysis of a prospective cohort of women delivering by cesarean or vaginal birth after cesarean conducted by the National Institute of Child Health and Human Development (NICHD) Maternal–Fetal Medicine Unit. Women delivering ≥ 20 weeks with platelets < 400,000/mL were included. Thrombocytopenia was defined as predelivery platelets of < 150,000/mL. Primary outcomes were (1) laboratory evidence of hemorrhage, defined as a decrease in hemoglobin ≥ 4 mg/dL and (2) clinical evidence of hemorrhage, a composite of atony, transfusion, coagulopathy, hysterectomy, laparotomy, or intensive care unit admission. Odds ratios were calculated for primary outcomes using thrombocytopenia as a dichotomous and ordinal variable.

Results A total of 54,597 women were included; 5,611 (10.3%) had antepartum thrombocytopenia, 1,976 (3.6%) women had laboratory evidence of hemorrhage, and 3,862 (7.1%) had clinical evidence of hemorrhage. Thrombocytopenia was associated with both laboratory evidence of hemorrhage (adjusted odds ratio [aOR]: 1.60, 95% CI: 1.38–1.86) and clinical evidence of hemorrhage (aOR: 1.68, 95% CI: 1.52–1.83). The odds of laboratory and clinical evidence of hemorrhage increased incrementally with severity of thrombocytopenia.

Conclusion Thrombocytopenia is associated with both laboratory and clinical evidence of hemorrhage; risk increases dramatically as platelet count decreases.

Condensation

The risk of postpartum hemorrhage is directly proportional to the severity of thrombocytopenia.


Note

This study was presented, in part, as a poster at the 37th Annual Pregnancy Meeting of the Society for Maternal–Fetal Medicine from January 22 to 28, 2017 at Las Vegas, NV (final abstract no. 644).


Funding

None.