Oral Presentation Society of Obstetric Medicine of Australia and New Zealand and Australasian Diabetes in Pregnancy Society Joint Scientific Meeting 2017

Thrombocytopenia in Pregnancy: an overview of current Australian practice (#29)

Renee Eslick 1 , Penelope Motum 2 , Giselle Kidson-Gerber 3 , Jenny Curnow 4 , Yvonne Brennan 4 , Barbara Garcia 3
  1. Obstetric Medicine Department, Auckland City Hospital, Auckland, New Zealand
  2. Haematology Department, Liverpool Hospital, Sydney, NSW, Australia
  3. Haematology Department, Royal Women's Hospital, Sydney, NSW, Australia
  4. Haematology Department, Westmead Hospital, Sydney, NSW, Australia

Introduction

Thrombocytopenia is frequently encountered in obstetric haematology clinics.

Objectives

We aimed to review the causes of thrombocytopenia in Australian women referred to haematology and assess their clinical outcomes. Secondary aims included evaluating how pregnant women with idiopathic thrombocytopenia (ITP) respond to different treatments; and assessing the safety and availability of neuraxial anaesthesia.

Methods

We conducted a multicentre prospective observational study of pregnant patients with thrombocytopenia, defined as a platelet count below 150x109/L, referred for haematology evaluation. Patients were recruited over six months at four hospitals within NSW. Data was collected on maternal age and parity, comorbidities, treatment administered, labour analgesia, and maternal and neonatal outcomes. Ethics approval was obtained.

Results

59 patients were eligible for inclusion with a median age of 30, parity of 2 and gravida of 1. The most frequent diagnosis was gestational thrombocytopenia (51%), followed by ITP (37%), preeclampsia (3%), familial thrombocytopenia (3%), artefactual (3%), and myelodysplastic syndrome (2%). The platelet count for women with ITP was significantly lower throughout pregnancy than gestational thrombocytopenia (nadir 62 vs 91, p=0.0001), except at the time of delivery (102 vs 89, p=0.085). The incidence of postpartum haemorrhage (PPH) was higher than the national average at 24%, with women with gestational thrombocytopenia experiencing similar rates of PPH to women with ITP. The incidence of thrombocytopenia in babies born to mothers with ITP was 18%, with no haemorrhagic complications. Prednisone and IVIG had similar efficacy in ITP. No complications of neuraxial anaesthesia occurred but seven women were declined an epidural, including four with a stable platelet count above 80x109/L.

Conclusions

Medical causes of thrombocytopenia are seen more frequently in obstetric haematology clinics. The incidence of PPH was increased, even in women with gestational thrombocytopenia. No complications of neuraxial anaesthesia were observed, but this intervention was not offered to all eligible women.