Department of Obstetrics & Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
J Thromb Thrombolysis. 2023 Apr;55(3):571-575. doi: 10.1007/s11239-022-02756-9. Epub 2023 Jan 2.
Both thrombocytopenia (platelet count < 150 × 10/µL) and anemia have been associated with postpartum hemorrhage (PPH). However, the impact of thrombocytopenia on PPH risk among women with mild and severe anemia is unknown. We sought to evaluate the association between thrombocytopenia and anemia in increasing risk of PPH. We performed a secondary analysis of a retrospective cohort of pregnant women from 19 hospitals across the United States from 2016 to 2021. Women who had a term singleton pregnancy and hematocrit (Hct) ≤ 33% at delivery were included in the study. The primary outcome was PPH (defined as blood loss ≥ 1000 mL or blood transfusion). We also analyzed the effect of severe anemia (Hct < 28%) on the association between PPH and thrombocytopenia. Chi-squared tests and Fisher's exact tests were used for categorical variables and an independent t-test was used for continuous variables. There were 20,808 women who met our inclusion criteria, of which 1793 (8.6%) had platelet count < 150 × 10/µL. The prevalence of PPH was 6.4%. Compared with women with normal platelet count, those with thrombocytopenia had 1.3-fold higher odds of PPH [6.8% vs. 4.5%, adjusted OR 1.3 (1.1-1.7)]. Platelet count ≥ 150 × 10/µL was associated with decreased odds of PPH among patients with hct between 28 and 33% and hct < 28%. In conclusion, anemic women with term singleton pregnancies who delivered with thrombocytopenia had a higher frequency of PPH. Normal platelet count at delivery was protective against PPH in the setting of anemia regardless of severity.
血小板减少症（血小板计数 < 150×10/µL）和贫血均与产后出血（PPH）有关。然而，血小板减少症对轻度和重度贫血妇女发生 PPH 风险的影响尚不清楚。我们旨在评估血小板减少症与贫血在增加 PPH 风险方面的关系。我们对美国 19 家医院的 2016 年至 2021 年期间的孕妇进行了回顾性队列研究的二次分析。研究纳入具有足月单胎妊娠且分娩时血细胞比容（Hct）≤33%的妇女。主要结局为 PPH（定义为出血量≥1000mL 或输血）。我们还分析了重度贫血（Hct<28%）对 PPH 和血小板减少症之间关系的影响。对于分类变量，使用卡方检验和 Fisher 确切检验，对于连续变量，使用独立 t 检验。符合纳入标准的妇女共有 20808 例，其中 1793 例（8.6%）血小板计数<150×10/µL。PPH 的发生率为 6.4%。与血小板计数正常的妇女相比，血小板减少症妇女发生 PPH 的几率增加了 1.3 倍[6.8%比 4.5%，校正 OR 1.3（1.1-1.7)]。血小板计数≥150×10/µL 与 hct 在 28%至 33%和 hct<28%之间的患者发生 PPH 的几率降低相关。结论：患有足月单胎妊娠且分娩时发生血小板减少症的贫血妇女发生 PPH 的频率更高。无论贫血严重程度如何，分娩时的正常血小板计数都可以预防 PPH。
