Oral Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2018

A retrospective analysis of the degree of maternal thrombocytopenia and severity of sepsis in pregnant women (#36)

Natalie Cromer 1 2 , Isabella Townshend 1 , Raiyomand Dalal 1 3 , Renuka Shanmugalingam 1 2 , Annemarie Hennessy 1 2 , Angela Makris 1 2
  1. Western Sydney University, Campbelltown, NSW, Australia
  2. Department of Renal Medicine, South Western Sydney Local Health District, Sydney, NSW, Australia
  3. Department of Obstetrics and Gynaecology, South Western Sydney Local Health District, Sydney, NSW, Australia

Introduction

Early signs of maternal sepsis may be concealed by the normal physiological changes in pregnancy.  The inverse relationship between platelet count and sepsis has been shown to be a marker of increased morbidity and mortality however this has not been examined in the pregnant population.

 

Objectives

We aimed to assess the prognostic significance of thrombocytopenia in pregnant women with sepsis.

 

Methods

We conducted a retrospective audit of patient files and electronic medical records of all pregnant and post-partum women admitted to the Intensive Care Unit (ICU) in Campbelltown Hospital from 2010-2016. We reviewed data and outcomes of 193 women admitted to ICU. Women with sepsis were isolated and analysed. A clinical definition of sepsis was used to include women who had documented infection, fever >38oC, any anti-viral use, any anti-fungal use and ≥2 antibiotics used. Thrombocytopenia was defined as a 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). Maternal morbidity was measured by acute kidney injury (AKI) (creatinine >88micromol/L), need for intubation and ionotropic support, need for >2 antimicrobial agents, fibrinogen level of <2.0g/L. Statistical analysis was done utilising chi-square and Kruskal-Wallis analysis with p<0.05 deemed significant (SPSSv25).

 

Results

There were 117 women with sepsis identified. Thrombocytopenia developed in 38.5% (n=45). Patients who developed thrombocytopenia had a higher rate of AKI (p=0.025). There was a statistically significant association between degree of thrombocytopenia and need for intubation (p=0.003), need for inotropic support (p=0.04), AKI (p=0.04) and duration of ICU stay (p=0.01). The fibrinogen was similar between groups (p=0.9) however fibrinogen level was only measured in 36% of patients with thrombocytopenia and 40% of those with normal platelet counts.

 

Conclusions

Thrombocytopenia is common in pregnant patients who are admitted to ICU with sepsis. Women with thrombocytopenia had a higher rate of AKI compared to those with normal platelet counts. The degree of thrombocytopenia was associated with increased severity of sepsis.