Platelet Adhesiveness and Aggregation Following Caesarean Section and Gynaecological Operations

Abstract

AND CHANGES in platelet adhesiveness following parturition and surgical operations have been described by Payling Wright (1942). In 13 primiparae and in 11 surgical patients (male and female) she demonstrated that immediately after delivery or operation there was little change in platelet adhesiveness, but from the 4th day onwards there was a steady increase in the platelet count and in platelet adhesiveness which reached a maximum on the 10th day. The healthy mothers were discharged from hospital on the 14th day. In the surgical cases, platelet adhesiveness decreased after the 10th day and reached a normal value by the 21st day.In a recent study we have found that platelet adhesiveness remains unchanged throughout pregnancy and labour but rises in the immediate puerperium, i.e. within 72 hours of delivery. By the 3rd to 5th day platelet adhesiveness had significantly decreased, and by the 10th day platelet adhesiveness was below the level seen before delivery (Shaper et al., 1968). In the present study we have examined platelet adhesiveness and other phenomena in women undergoing Caesarean section and repair operations for vesico-vaginal fistula, in an attempt to repeat the original investigations into platelet adhesiveness carried out by Wright (1942). CLINICAL MATERIAL Caesarean SectionTwenty-one African women aged 16 to 34 years (average 23 years) undergoing Caesarean section were studied. Nineteen women had elective operations for disproportion. Eight of these 19 patients had previously had Caesarean section operations and six had undergone a prolonged second stage of labour. The two remaining patients were operated on during labour, one for a prolapsed cord and one for uterine inertia. Three subjects received blood transfusion postoperatively on the day of operation.It was originally intended to study all subjects preoperatively and then on the 1st (1st or 2nd), 4th (3rd to 5th), 7th (6th to 8th) and 10th (9th to 12th) postoperative days. It was usually not possible to obtain co-operation and consent for the repeated venepunctures, and only those subjects who were studied preoperatively and at least once thereafter were included in this study. Eleven of the 21 women were studied preoperatively and on the 10th day, and six of these were also studied on the 4th day. Only two subjects were studied on all five possible occasions, and nine subjects were studied on four of the five possible occasions. Almost all the patients in this study were fully ambulant by the 4th or 5th day following operation.Three women of Indian origin, who had undergone Caesarean section were studied preoperatively and on the 1 st, 4th, 7th and 10th days postoperatively. These women live on a different diet to the African women, have a different pattern of weight gain and blood lipid changes during pregnancy and the puerperium, and represent a wealthier socio-economic group. 442