Abstract
BackgroundThe occurrence of thrombocytopenia is as high as 7–12% in pregnancy, yet minimum platelet count safe for cesarean section remains unknown.MethodsIn this retrospective noninferior cohort study, we consecutively included patients undergoing cesarean section for a period of 6 years in a tertiary hospital and excluded patients at very high risk for excessive hemorrhage. The included patients with preoperative platelet count of 50–100 × 109/L were defined as the thrombocytopenic group. The control group were eligible patients with preoperative platelet count>150 × 109/L, matched to the thrombocytopenic group by age and operation timing in a 1:2 ratio. Mixed effect model was used to analyze the effect of thrombocytopenia based on a noninferiority assumption. The predefined noninferiority delta of bleeding was 50 mL.ResultsThere was no significant difference of the calculated blood loss between the thrombocytopenic and the control group (mean difference = 8.94, 95% CI − 28.34 mL to 46.09 mL). No statistical difference was observed in the requirement for blood transfusion, visually estimated blood loss, or the incidence of adverse events between groups. Although there were more patients admitted to intensive care unit (odds ratio = 12, 95% CI 2.69–53.62, p = 0.001) in the thrombocytopenic group, most of them required critical care for reasons other than hemorrhage. The thrombocytopenic group had longer length of hospital stay (mean difference = 0.40 days, 95% CI 0.09–0.71, p = 0.011), but the difference was considered as clinically insignificant.ConclusionsPreoperative moderate thrombocytopenia is not associated with increased blood loss, blood transfusion, or occurrence of adverse events in patients undergoing cesarean section in absence of additional bleeding risk.
Highlights
It has been recommended by guidelines that a preoperative platelet (PLT) count of 50× 109/L or greater is safe for elective major surgery except neurosurgery or ophthalmic surgery involving the posterior segment of the eye [1, 2]
To the best of our knowledge, there is scarce convincing evidence indicating the impact of preoperative moderate thrombocytopenia (PLT 50–100 × 109/L) on blood loss for cesarean section (CS)
To reduce the impact of other factors that may affect blood loss or transfusion requirement, we excluded patients with: (1) abnormal coagulation test, anti-coagulation, or antiplatelet therapy within 1 week prior to surgery; (2) previous history of postpartum hemorrhage (PPH) or platelet dysfunction; (3) abnormal placentation, including placenta previa, vasa previa, placenta accreta, and placental abruption; (4) preoperative spontaneous hemorrhage, active bleeding, or anemia; (5) prophylactic platelet transfusion which was defined as platelet transfusion within 7 days prior to CS
Summary
It has been recommended by guidelines that a preoperative platelet (PLT) count of 50× 109/L or greater is safe for elective major surgery except neurosurgery or ophthalmic surgery involving the posterior segment of the eye [1, 2]. The strength of such recommendation is weak due to the very low quality of evidence. To the best of our knowledge, there is scarce convincing evidence indicating the impact of preoperative moderate thrombocytopenia (PLT 50–100 × 109/L) on blood loss for cesarean section (CS). The occurrence of thrombocytopenia (PLT less than 150 × 109/L) is as high as 7–12% in pregnancy [3]. The occurrence of thrombocytopenia is as high as 7–12% in pregnancy, yet minimum platelet count safe for cesarean section remains unknown
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