Aim: Thrombocytopenia is a common haematological complication in pregnancy. Data on moderate to severe cases (platelets <100 x 109/L) are limited. This study aims to investigate aetiology and peripartum management in this subgroup.
Method: We performed a single-centre retrospective study conducted at Northern Health in Victoria. Pregnancies with platelets < 100 x109/L between January 2019 to December 2024 were included. Outcome measures were: causes of thrombocytopenia; peri-partum management, including mode of delivery, use of neuraxial anaesthesia, and thrombocytopenia-targeted therapies; postpartum haemorrhage (PPH) and blood products usage; neonatal platelet count and bleeding in immune thrombocytopenia (ITP) pregnancies.
Results: 117 pregnancies were included. The most common aetiology was gestational thrombocytopenia (n=83, 70.9%) followed by ITP (n=25, 21.4%), and hypertensive disorders (n=8, 6.9%). Mean nadir platelet count was 77.1 +/- 18.1 x 109/L. Overall, 61 (53.0%) pregnancies received neuraxial anaesthesia at delivery without bleeding complications. PPH occurred in 40 pregnancies (34.8%), of which five (4.3%) required red blood cell transfusions, with no associations between thrombocytopenia severity and PPH risk. In the ITP cohort, 16 (65%) pregnancies received steroids, intravenous immunoglobulin and/or platelet transfusions, with eight (32%) achieving platelet count >70x109/L peripartum. Four (16%) out of 22 neonates born to ITP pregnancies had thrombocytopenia in the first seven days without haemorrhagic complications.
Conclusion: Moderate thrombocytopenia during pregnancy does not confer increased risk of maternal and neonatal haemorrhage. Neuraxial anaesthesia can be safely administered. Early treatment of ITP could improve peripartum platelet count. Larger, multi-site prospective study would enable more impactful statistical analysis.