Evaluation of thrombocytopenia as a near miss criterion
Journal Title: MRIMS Journal of Health Sciences - Year 2017, Vol 5, Issue 1
Abstract
Background: Thrombocytopenia is defined as a platelet count below 150 x 109 / liter in adults, caused by accelerated platelet destruction or decreased production. It is classified as mild [platelet counts 100 – 150 x 109/ liter], moderate [platelet counts 50 – 100 x 109 / L] and severe [platelet counts less than 50 x 109 / L] Objective: The aim was to determine the incidence of severe thrombocytopenia in the maternal near miss cases and study the outcome and characteristics of these mothers with thrombocytopenia, with and without hypertension. Methods: An audit of cases that were diagnosed to be maternal near miss from January 2011 to December 2014 was undertaken at Fernandez Hospital, which is a private tertiary referral perinatal center with 8000 deliveries annually. WHO criteria [2009] were applied for defining maternal near miss morbidity. The incidence of severe thrombocytopenia [platelet count less than 50,000 per cu mm] was assessed, and the patients were divided into two groups based on the presence or absence of hypertension. The etiology of thrombocytopenia and outcomes [MNM morbidity indicators] and maternal deaths were studied. Results: During the study period we had 263 maternal near miss cases in 28,836 deliveries giving an incidence of 9/1000 live births. Severe thrombocytopenia [platelet counts < 50,000 per cu mm] was present in 103 mothers. Out of these cases of severe thrombocytopenia hypertension was present in 47 mothers and 56 mothers were normotensive. The study group of thrombocytopenia with hypertension had less incidence of postpartum hemorrhage [17% versus 23%] but with higher morbidity in the form of need for ventilation not related to anesthesia [34% versus 28%] and similar transfusion needs, and higher incidence of acute kidney injury and jaundice. Perinatal deaths and maternal deaths were higher in the hypertension group. Conclusion: In mothers with thrombocytopenia and maternal near miss, hypertension is a predictor of adverse fetal outcomes but not of adverse maternal outcomes.
Authors and Affiliations
Ramanan Duraiswami
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