Mild thrombocytopenia prior to elective cesarean section is an independent risk factor for blood transfusion

Archives of Gynecology and Obstetrics (2021)Cite this article

Abstract

Purpose

Thrombocytopenia is the second most common hematological disorder in pregnancy and complicates approximately 10% of all pregnancies. The data regarding the association of mild thrombocytopenia in women undergoing cesarean section and risk of bleeding or bleeding-related complications are scarce. Thus, the aim of the current study was to assess the association of mild thrombocytopenia with hemorrhage-related morbidities, among patients undergoing elective cesarean section.

Methods

We performed a retrospective cohort study, in a single tertiary university-affiliated medical center, between 1 January 2012 and 31 May 2019. Medical charts of women who underwent elective cesarean section at term (37+0/7–41 + 6/7 weeks of gestations) were retrieved and analyzed. We compared women with mild thrombocytopenia (platelet count of 100–149 × 103/μL) to women with normal platelet count (150–450 × 103/μL). The primary outcome was the need for red blood cell transfusion during the index admission. A secondary outcome was severe bleeding not requiring blood transfusion defined as postpartum hemoglobin decline of  ≥ 3 g/dL as compared to the prepartum levels.

Results

During the study period, 1577 women were included in the final analysis, of them 396 (25.11%) had mild thrombocytopenia prior to delivery. As compared to the control group, women with mild thrombocytopenia had higher rates of blood transfusion (3.79 vs. 1.52%, p = 0.01), and had a significant decline in hemoglobin levels.

In a multivariable logistic regression model, mild thrombocytopenia was independently associated with blood transfusion with adjusted OR of 2.34 (95% CI 1.10–4.96, p = 0.03).

Conclusion

Preoperative mild thrombocytopenia is associated with an increased risk of blood loss and blood transfusion in women undergoing elective CS. More studies are required to assess those observations in context of urgent cesarean sections and whether any preventive measures can reduce the risk for bleeding.

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Funding

The study was not funded.

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Affiliations

  1. Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Weitzman 6 St., 6423906, Tel Aviv, Israel

    Emmanuel Attali, Lee Reicher, Michael Lavie, Yariv Yogev & Liran Hiersch

  2. Critical Care Division, Rambam Health Care Campus, Haifa, Israel

    Danny Epstein

Authors
  1. Emmanuel Attali
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  2. Danny Epstein
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  3. Lee Reicher
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  4. Michael Lavie
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  5. Yariv Yogev
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  6. Liran Hiersch
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Contributions

We hereby declare that the following authors have contribute to the manuscript. EA: conceptualization, data collection, Author—primary. DE: statistics and formal analysis. LR: data collection and validation. ML: up-to-date literature collection. YY: supervision, review, and editing. LH: supervision, review, and editing.

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Correspondence to Emmanuel Attali.

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The authors declared that they have no conflict of interest.

Informed consent

This study was approved by the Institutional Review Board (IRB) which waived the requirement of informed consent (Approval 0284–08).

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Attali, E., Epstein, D., Reicher, L. et al. Mild thrombocytopenia prior to elective cesarean section is an independent risk factor for blood transfusion. Arch Gynecol Obstet (2021). https://doi.org/10.1007/s00404-021-05988-x

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Keywords

  • Thrombocytopenia
  • Postpartum hemorrhage
  • Blood transfusion
  • Cesarean section