Thrombocytopenia in Pregnancy Induced Hypertension

Abstract

Background: Pregnancy induced hypertension (PIH) is one of the most common causes of both maternal and neonatal morbidity. A variety of hematological abnormalities may occur in women with PIH of which thrombocytopenia is the most common. Objectives: This study was done to estimate the incidence of thrombocytopenia in pregnant women diagnosed with PIH and to correlate the severity of PIH with the degree of thrombocytopenia. Materials and Methods: 2 years retrospective study on 100 pregnant women admitted in MVJMC and RH with a diagnosis of PIH from January 2012 to January 2014. Data from case files were collected, compiled, and analyzed. PIH cases were classified into: (1) Gestational hypertension (HTN), (2) mild preeclampsia, (3) severe preeclampsia, (4) eclampsia, (5) hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome. The incidence and severity of thrombocytopenia along with maternal and fetal complications encountered in the five groups were analyzed. Results: Preeclampsia - mild (56%) and severe (36%), accounted for most of the cases followed by eclampsia (6%) and gestational HTN (2%). In the 100 cases, mild thrombocytopenia (41%), moderate thrombocytopenia (29%), severe thrombocytopenia (6%), and normal platelet counts (24%) were encountered. Varying platelet levels were seen in the five groups with 23.4% of severe eclampsia and 50% of eclampsia cases having normal platelet counts and 7.1% of mild preeclampsia cases showing severe thrombocytopenia. Poor maternal outcome was seen 11% cases due to HELLP syndrome, postpartum hemorrhage, and maternal death. Poor fetal outcome was seen in 18% cases due to intrauterine growth restriction and perinatal mortality. Conclusion: Platelet count alone cannot be relied upon to assess the severity of PIH. The search for a simple cost effective test for prompt management and prevention of maternal and neonatal morbidity performable in a rural hospital set up still continues.