Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC (Drs DiSciullo, Mokhtari, and Kawakita).
Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, DC (Dr Landy).
Am J Obstet Gynecol MFM. 2021 Jul;3(4):100368. doi: 10.1016/j.ajogmf.2021.100368. Epub 2021 Apr 6.
Thrombocytopenia at the time of delivery is considered as a risk factor for postpartum hemorrhage. However, platelet count thresholds for postpartum hemorrhage are variable and not extensively studied.
This study aimed to examine whether mild thrombocytopenia is associated with an increased risk of postpartum hemorrhage among women undergoing cesarean delivery.
This was a retrospective cohort study of all women who underwent cesarean delivery at a tertiary care hospital labor and delivery unit from September 2015 to June 2018. Women with normal platelet counts (≥150,000/µL) were compared with women with mild thrombocytopenia (100,000-149,000/µL). Women were excluded if they had moderate to severe thrombocytopenia (platelet count of <100,000/µL) or had received a platelet transfusion. The primary outcome was postpartum hemorrhage (quantitative blood loss of ≥1000 mL). Secondary outcomes included frequencies of red blood cell transfusion, wound complications (surgical site infections, dehiscence, or hematoma), and postpartum emergency department visits. Adjusted odds ratios with 95% confidence intervals were calculated, controlling for maternal age, gestational age, body mass index, scheduled cesarean delivery, hypertension, and preoperative hemoglobin level.
Of 3133 women, 2799 (89.3%) had normal platelet levels, 298 (9.5%) had mild thrombocytopenia, and 36 (1.2%) had moderate to severe thrombocytopenia. There were no differences in the risks of postpartum hemorrhage, need for a red blood cell transfusion, wound complications, or postpartum emergency department visit comparing women with normal platelet counts with those with mild thrombocytopenia (24.6% vs 25.8% [adjusted odds ratio, 1.16; 95% confidence interval, 0.88-1.54]; 6.5% vs 6.7% [adjusted odds ratio, 1.34; 95% confidence interval, 0.80-2.24]; 4.5% vs 5.4% [adjusted odds ratio, 1.53; 95% confidence interval, 0.88-2.64]; 9.0% vs 10.7% [adjusted odds ratio, 1.37; 95% confidence interval, 0.92-2.03], respectively).
Preoperative mild thrombocytopenia was not associated with postpartum hemorrhage, red blood cell transfusion, wound complications, or postpartum emergency department visits in women undergoing cesarean delivery.
分娩时血小板减少被认为是产后出血的危险因素。然而，产后出血的血小板计数阈值是可变的，并且尚未得到广泛研究。
本研究旨在探讨轻度血小板减少症是否与剖宫产妇女产后出血风险增加有关。
这是一项回顾性队列研究，纳入了 2015 年 9 月至 2018 年 6 月在一家三级保健医院分娩病房行剖宫产的所有妇女。将血小板计数正常（≥150,000/µL）的妇女与血小板计数轻度减少（100,000-149,000/µL）的妇女进行比较。排除血小板计数中度至重度减少（血小板计数＜100,000/µL）或接受血小板输注的妇女。主要结局是产后出血（出血量≥1000 mL）。次要结局包括红细胞输注频率、伤口并发症（手术部位感染、裂开或血肿）和产后急诊就诊。在控制了产妇年龄、胎龄、体重指数、择期剖宫产、高血压和术前血红蛋白水平后，计算了调整后的比值比及其 95%置信区间。
在 3133 名妇女中，2799 名（89.3%）血小板水平正常，298 名（9.5%）有轻度血小板减少症，36 名（1.2%）有中重度血小板减少症。与血小板计数正常的妇女相比，血小板计数轻度减少的妇女产后出血、需要红细胞输注、伤口并发症或产后急诊就诊的风险无差异（24.6%比 25.8%[调整后的比值比，1.16；95%置信区间，0.88-1.54]；6.5%比 6.7%[调整后的比值比，1.34；95%置信区间，0.80-2.24]；4.5%比 5.4%[调整后的比值比，1.53；95%置信区间，0.88-2.64]；9.0%比 10.7%[调整后的比值比，1.37；95%置信区间，0.92-2.03]）。
剖宫产术前轻度血小板减少症与产后出血、红细胞输注、伤口并发症或产后急诊就诊无关。
