Maternal and neonatal outcomes in pregnant women with severe thrombocytopenia: insights from a retrospective 8-year cohort study in China.

BACKGROUND

Severe thrombocytopenia during pregnancy is uncommon but poses substantial challenges for obstetric management because of potential maternal bleeding and adverse neonatal outcomes. However, the relationship between the severity of maternal thrombocytopenia and maternal-neonatal outcomes remains unclear.

OBJECTIVES

To characterize clinical features and maternal and neonatal outcomes across different platelet count strata in pregnant women with severe thrombocytopenia.

METHODS

We conducted a retrospective analysis of 175 cases over an 8-year period. Etiology, maternal characteristics, and maternal-neonatal outcomes were compared across 3 platelet count strata: ≤10, >10 to ≤20 × 109/L, and >20 to ≤30 × 109/L. Statistical analyses included t-tests, Kruskal-Wallis H tests, chi-square tests, and analysis of variance.

RESULTS

Primary immune thrombocytopenia was the predominant etiology (62.3%, 109/175). The incidence of postpartum hemorrhage was highest in the platelet count ≤ 10 × 109/L group (12.5%) than in the >10 to ≤20 × 109/L (4.8%) and >20 to ≤30 × 109/L (3.6%) groups. Preterm birth was also more common in the platelet count ≤ 10 × 109/L group (58.9%) than in the >10 to ≤20 × 109/L (27.0%) and >20 to ≤30 × 109/L (23.2%) groups. Neonatal thrombocytopenia rates were 33.9%, 23.8%, and 14.3% in the 3 groups, respectively. The overall rate of neonatal intracranial hemorrhage was 3.4% (6/175).

CONCLUSION

Primary immune thrombocytopenia is the leading cause of severe thrombocytopenia during pregnancy. A lower platelet count, particularly ≤10 × 109/L, is associated with an increased risk of preterm birth and postpartum hemorrhage. Neonatal intracranial hemorrhage is a rare complication. Severe thrombocytopenia may be associated with preterm delivery, but no statistical difference in the incidence of neonatal thrombocytopenia was observed across the maternal platelet strata in this study.