Obstetric haemorrhage is a serious complication of pregnancy that may result in major maternal morbidity and mortality. Thrombocytopenia is a common haematologic complication in pregnancy that is both a risk factor for obstetric haemorrhage and a consequence of massive bleeding and disseminated intravascular coagulation.
We aimed to assess the relationship between varying degrees of thrombocytopenia and severity of bleeding in women admitted into the Intensive Care Unit (ICU) for the management of obstetric haemorrhage.
We conducted a retrospective audit of patient files and electronic medical records of all pregnant and post-partum women admitted to the ICU in Campbelltown Hospital from 2010-2016. We reviewed data and outcomes of 193 women admitted to ICU. Women admitted to ICU post-partum with obstetric haemorrhage were isolated and analysed. Maternal thrombocytopenia was defined as platelet count of <150x10^9/L during admission, with further division into mild (100-149x10^9/L), moderate (50-99x10^9/L) and severe (<50x10^9/L). Degree of haemorrhage was assessed on the extent of management (localised management, systemic management +/- surgical intervention, hysterectomy), volume of blood loss and need for blood transfusion. Statistical analysis was undertaken utilising chi-square and Kruskal-Wallis analysis with p<0.05 deemed significant (SPSSv25).
There were 45 women with obstetric haemorrhage identified. Thrombocytopenia was present in 60% (n=27). Patients with normal platelet counts were more likely to have localised management only (p=0.04) and women with thrombocytopenia had a higher rate of requiring surgical and systemic management of bleeding (p=0.03). Hysterectomy was required in 30% (n=8) of patients with thrombocytopenia (p=0.01). When thrombocytopenia was divided into mild (n=15), moderate (n=10) and severe (n=2) there was a statistically significant association between degree of thrombocytopenia and requirement for surgical management (p=0.034) and hysterectomy (p=0.02).
There was an association between thrombocytopenia throughout admission and rate of surgical management including hysterectomy. This may be due to pre-existing thrombocytopenia or consumption following haemorrhage. There was no relationship between blood loss and transfusion requirements and platelet count.