Mild thrombocytopenia and the risk for postpartum hemorrhage in twin pregnancies

Abstract

Thrombocytopenia, defined as a platelet count of less than 150 000/ μL 1 complicates approximately 10% of all pregnancies. 2-4 However, the prevalence of thrombocytopenia is much higher in multi-fetal pregnancies and its reported rate is as high as 17-36.5%. [5][6][7] This high rate of thrombocytopenia can be partially explained by the enhanced platelet reactivity and hemodilution, which is more pronounced in multiple gestations as compared to singletons. 5 The association of mild thrombocytopenia, defined as a platelet count between 100 000 and 149 999/μL 1 with hemorrhage-related morbidities and postpartum hemorrhage (PPH) has been studied in the general obstetric population, mainly focusing on singleton pregnancies. 1,2,[8][9][10][11] Recently, higher rates of PPH were reported in

Hemostatic biomarkers associated with postpartum hemorrhage: a systematic review and meta-analysis

“…The 2 researchers read then the remaining 117 full-text articles and excluded 36 more articles, which led to the final inclusion of 81 articles in the qualitative synthesis. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , ...…”

“…In total, 17 articles were analyzed, corresponding to 26 654 pregnant women, with 3746 cases of PPH and 1167 cases of severe PPH. 8 , 11 , 12 , 14 , 18 , 24 , 26 , 38 , 40 , 42 , 53 , 57 , 58 , 61 , 69 , 71 , 85 The characteristics of the women are provided in Table 1 .…”

Risk factors for postpartum hemorrhage in twin pregnancies with cesarean section

“…The increased incidence of thrombocytopenia in twin pregnancies may be attributed to the enhanced platelet reactivity, ( 21 ) greater hemodilution ( 8 ) as compared to singleton pregnancies, or both. A study of 1,085 women with twin gestations found a greater incidence of PPH in women with mild thrombocytopenia compared with those with normal platelet count ( 10 ). Additionally, moderate thrombocytopenia ( 22 ) and severe thrombocytopenia ( 8 ) were also convinced to be risk factors for PPH in twin pregnancies.…”

“…Several studies have been performed to explore the risk factors for PPH in twin deliveries but they have mainly focused on only one risk factor, and the mode of delivery includes both vaginal births and cesarean deliveries (9)(10)(11). A study led by Blitz et al (8) has attempted to develop a predictive model for PPH in twin births, but they focused on PPH with packed red blood cells.…”

Is Grand Multiparity an Independent Risk Factor for Blood Transfusion?

“…There are several known risk factors for PPH including macrosomia 3 , instrumental delivery 4 , history of PPH 5 , antenatal anemia and thrombocytopenia 6 , and multiple gestations, 7 . Even in the absence of clinical PPH, maternal blood loss and hemoglobin (HB) decline can lead to postpartum anemia which may adversely affect maternal health 8,9 .…”