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

Attali, Emmanuel; Epstein, Danny; Reicher, Lee; Lavie, Michael; Yogev, Yariv; Hiersch, Liran

doi:10.1007/s00404-021-05988-x

Cited by 11 publications

(8 citation statements)

References 19 publications

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“…Notably, platelet count >150 appears to be protective of PPH. Recent data has shown that mild thrombocytopenia is an independent risk factor for PPH[30,31]. Nonetheless, our cohort provided robust data clearly showing an increasing risk of hemorrhage with decreasing platelet for both vaginal and Cesarean deliveries.…”

Section: Discussionsupporting

confidence: 48%

Improving postpartum hemorrhage risk prediction using longitudinal electronic medical records

Zheutlin

Vieira

et al. 2021

Preprint

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ObjectivePostpartum hemorrhage (PPH) remains a leading cause of preventable maternal mortality in the US. Our goal was to develop a novel risk assessment tool and compare its accuracy to those used in current practice.Materials and MethodsWe used a PPH digital phenotype we developed and validated previously to identify 6,639 cases from our delivery cohort (N=70,948). Using a vast array of known and potential risk factors extracted from electronic medical records available prior to delivery, we trained a gradient boosting model in a subset of our cohort. In a held-out test sample, we compared performance of our model to three clinical risk tools and one previously published model.ResultsOur 24-feature model achieved an area under the curve (AUC) of 0.71 (95% confidence interval [CI], 0.69-0.72), higher than all other tools (research-based AUC: 0.67 [95%CI, 0.66-0.69], clinical AUCs: 0.55 [95%CI, 0.54-0.56] to 0.61 [95%CI, 0.59-0.62]). Five features were novel including red blood cell indices and infection markers measured standardly upon admission. Additionally, we identified inflection points for several vital signs and labs where risk rose substantially. Most notably, patients with median intrapartum systolic blood pressure above 132mmHg had an 11% [interquartile range, 4%] median increase in relative risk for PPH.ConclusionsWe developed a novel approach for predicting PPH and identified clinical feature thresholds that can guide intrapartum monitoring for PPH risk. Our results suggest our model is an excellent candidate for prospective evaluation and could ultimately reduce PPH morbidity and mortality through early detection and prevention.

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Section: Discussionsupporting

confidence: 48%

Improving postpartum hemorrhage risk prediction using longitudinal electronic medical records

Zheutlin

Vieira

et al. 2021

Preprint

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“…Recent data has shown that mild thrombocytopenia is an independent risk factor for PPH. 30 , 31 Nonetheless, our cohort provided robust data clearly showing an increasing risk of hemorrhage with decreasing platelet for both vaginal and cesarean deliveries. Furthermore, we found that hematocrit and hemoglobin values reflected differential risks for PPH for cesarean relative to vaginal deliveries.…”

Section: Discussionmentioning

confidence: 63%

Improving postpartum hemorrhage risk prediction using longitudinal electronic medical records

Zheutlin

Vieira

Shewcraft

et al. 2021

Journal of the American Medical Informatics Association

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Objective Postpartum hemorrhage (PPH) remains a leading cause of preventable maternal mortality in the United States. We sought to develop a novel risk assessment tool and compare its accuracy to tools used in current practice. Materials and Methods We used a PPH digital phenotype that we developed and validated previously to identify 6639 PPH deliveries from our delivery cohort (N = 70 948). Using a vast array of known and potential risk factors extracted from electronic medical records available prior to delivery, we trained a gradient boosting model in a subset of our cohort. In a held-out test sample, we compared performance of our model with 3 clinical risk-assessment tools and 1 previously published model. Results Our 24-feature model achieved an area under the receiver-operating characteristic curve (AUROC) of 0.71 (95% confidence interval [CI], 0.69-0.72), higher than all other tools (research-based AUROC, 0.67 [95% CI, 0.66-0.69]; clinical AUROCs, 0.55 [95% CI, 0.54-0.56] to 0.61 [95% CI, 0.59-0.62]). Five features were novel, including red blood cell indices and infection markers measured upon admission. Additionally, we identified inflection points for vital signs and labs where risk rose substantially. Most notably, patients with median intrapartum systolic blood pressure above 132 mm Hg had an 11% (95% CI, 8%-13%) median increase in relative risk for PPH. Conclusions We developed a novel approach for predicting PPH and identified clinical feature thresholds that can guide intrapartum monitoring for PPH risk. These results suggest that our model is an excellent candidate for prospective evaluation and could ultimately reduce PPH morbidity and mortality through early detection and prevention.

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“…Patients with GT did not experience increased bleeding or need for transfusion compared with controls. Previously published data regarding thrombocytopenia in pregnancy and bleeding have suggested evidence both for 20 and against 21 an increased risk of bleeding at delivery. These case series did not distinguish GT from other causes of thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

Gestational thrombocytopenia: a case–control study of over 3,500 pregnancies

Fogerty

Dzik

2021

Br J Haematol

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Gestational thrombocytopenia (GT) affects an estimated nine million women annually. Women with GT have recurrent episodes on subsequent pregnancies suggesting that GT is related to a maternal factor rather than a factor unique to the individual pregnancy. We performed a case-control study of over 3 500 pregnancies at a single hospital during 2017. We defined GT as any pregnancy with a platelet count <150 000/µl during the 100 days prior to delivery. We excluded women with platelet counts <50 000/µl or with conditions known to cause thrombocytopenia. GT was present in 12% of pregnancies. The median platelet count at delivery was 134 500/µl in cases versus 208 000/µl in controls, P < 0Á0001. During the pregnancy, the platelet count declined 31Á8% in cases compared with 18Á3% in controls (P < 0Á0001) in association with a significant increase in mean platelet volume during each trimester. Among women with GT, platelet counts rapidly increased during the first week postpartum, consistent with a mechanism directly related to high blood flow rates in the gravid uterus. GT, a recurrent condition of at-risk women, is a common haematological disorder of pregnancy. Future research may focus on genetic gainof-function polymorphisms resulting in increased turnover of platelets uncovered only during periods of high-shear blood flow.

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

Cited by 11 publications

References 19 publications

Improving postpartum hemorrhage risk prediction using longitudinal electronic medical records

Improving postpartum hemorrhage risk prediction using longitudinal electronic medical records

Improving postpartum hemorrhage risk prediction using longitudinal electronic medical records

Gestational thrombocytopenia: a case–control study of over 3,500 pregnancies

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