Maternal Thrombocytopenia Research Articles

Low Platelet Count Analysis as a Prognostic Indicator in Pregnancy-induced Hypertension

Introduction: Hypertension is one of the serious complications of pregnancy which virtually affects all maternal organs such as the liver, kidney, brain, and placenta. Changes in the hemostatic system are observed in normal and hypertensive patients. The frequency and intensity of maternal thrombocytopenia vary and are dependent on the intensity of the disease process and duration of pregnancy-induced hypertension (PIH) syndrome. In general, the lower the platelet counts, the higher the maternal and fetal morbidity and mortality. Aims and Objectives: The aims and objectives of the study were to study the platelet counts in cases of PIH, compare the values with normotensive pregnant participants, and study the association between thrombocytopenia and fetomaternal outcome. Materials and Methods: A total of 226 patients were included in the study and were evaluated for their platelet count and fetomaternal outcome. The patients were divided into two groups, with each group comprising 113 patients, namely, Group I which included controls and Group II which included patients with PIH (subgroups: gestational hypertension, preeclampsia, and eclampsia). Platelet counts in all groups were charted, compared, and correlated with various maternal parameters such as age, gravidity, severity of hypertension, gestational age of termination, maternal complications, and hospital stay. Fetal parameters studied were intrauterine growth restriction, stillbirth, neonatal intensive care unit care, and intrauterine fetal demise. Results: Our study found that the mean platelet count decreases with the severity of gestational hypertension. Thus, the highest platelet count was seen in the control group (D), i.e., 1.67 lakh/mm3 and the lowest platelet count was seen in the eclamptic group, (C) i.e., 0.75 lakh/mm3. Pregnancies complicated by thrombocytopenia were terminated at an earlier gestation (35–37 weeks). Maternal complications such as postpartum hemorrhage (56.5%) and stitch line ooze (27.5%) were found to occur more in the thrombocytopenic group. The association between birth weight and thrombocytopenia was statistically significant in our study. Conclusion: Thrombocytopenia associated with PIH is a reliable prognostic indicator for the severity of hypertension as well as the associated maternal and fetal morbidity.

Obstetrical Use of Intravenous Immunoglobulin at a Tertiary Care Canadian Center: A 14-Year Retrospective Study

Introduction: Intravenous immunoglobulin (IVIG) has gained widespread acceptance for the treatment of various medical conditions. However, its availability is limited, it incurs substantial costs, and reports of shortages have raised concerns regarding patient access. Additionally, adverse events with IVIG use underscore the need for prudent administration. While IVIG is approved for specific indications, its off-label use remains significant. Prior studies have addressed the general use of IVIG use and called for measures to ensure its appropriate application, research specific to the obstetrical use of IVIG is lacking. Understanding how IVIG is used in pregnancy could guide future research endeavours and shape policies aimed at optimizing patient care, minimizing unwarranted exposure, and containing healthcare costs. The objectives of this study are three-fold: (1) to assess the frequency, volume, and indications of IVIG use in pregnancy, (2) to assess the congruent use of IVIG with the approved Canadian indications and the approved conditions by the Ontario Immunoglobulin Utilization Management Guidelines, and (3) to compare the volume of IVIG used in pregnancy to the total volumes of IVIG use. Methods: This retrospective cohort study used administrative data and chart reviews to analyze all pregnant individuals between 2007 and 2020 who received IVIG during their pregnancy and delivered at a large tertiary care academic center with high-risk obstetrical care in Ontario, Canada. Data were collected on IVIG volumes, administration regimens, indications, and timing of administration during pregnancy. A descriptive analysis was performed to present the findings. Results: The study cohort comprised 122 pregnant patients, accounting for 136 deliveries. The cumulative volume of IVIG used across all obstetrical patients amounted to 41,107.50 grams, representing 1.6% of the total consumption of IVIG (2,575,766.50 grams) at our center. Among the indications for IVIG administration during pregnancy (Table 1), the most prevalent were maternal thrombocytopenia (77/136 deliveries, 56.6%) and antenatal therapy for Fetal/Neonatal Alloimmune Thrombocytopenia (F/NAIT) (22/136 deliveries, 16.2%). The highest IVIG consumption was observed in F/NAIT, with a total of 26,435 grams (64.3%) used in all pregnancies and a median of 1015 grams per pregnancy (IQR = 542.5, 1938.75). Maternal thrombocytopenia followed, accounting for a total of 6,952.50 grams (16.9%) used in all pregnancies and a median of 70 grams per pregnancy (IQR = 40, 90). We observed an overall increase in the trend of IVIG use in pregnancy and average volumes per delivery, but this remains a small proportion of total IVIG use (Figure 1). In terms of congruent use of IVIG, 38.2% of deliveries (52/136) did not meet the Canadian licensed indications for IVIG use, accounting for a large amount (33,025 grams, 80.3% of total volume used). However, 17.6% of deliveries (24 out of 136) did not adhere to the Ontario guidelines' indications for IVIG use, which constituted a total of 5,475 grams (13% of total volume used). Conclusions: The obstetrical use of IVIG represents a minor proportion of the total volume used at a large Canadian tertiary care center. Hematologic conditions, particularly F/NAIT and maternal thrombocytopenia, are the predominant drivers of IVIG administration during pregnancy. Recent reports on IVIG use in the general population demonstrated similarly high prescribing patterns of IVIG among hematologists, but also neurologists. Rational prescribing and dose minimization are important strategies to improve judicious and cost-effective use of IVIG. However, implementation of such strategies for obstetrical use of IVIG may be limited as evidence generally stems from small, retrospective, observational studies, and reaching a consensus among various specialists may sometimes prove difficult. There is a pressing need for prospective multicenter studies in pregnant individuals, particularly for conditions with high IVIG consumption. These studies would help to examine the efficacy and safety of IVIG during pregnancy and provide essential guidance for appropriate IVIG use in this unique patient population.

SARS-CoV-2-Placental effects and association with stillbirth.

SARS-CoV-2 has had a significant impact on pregnancy outcomes due to the effects of the virus and the altered healthcare environment. Stillbirth has been relatively hidden during the COVID-19 pandemic, but a clear link between SARS-CoV-2 and poor fetal outcome emerged in the Alpha and Delta waves. A small minority of women/birthing people who contracted COVID-19 developed SARS-CoV-2 placentitis. In many reported cases this was linked to intrauterine fetal death, although there are cases of delivery just before imminent fetal demise and we shall discuss how some cases are sub-clinical. What is surprising, is that SARS-CoV-2 placentitis is often not associated with severe maternal COVID-19 infection and this makes it difficult to predict. The worst outcomes seem to be with diffuse placental disease which occurs within 21 days of COVID-19 diagnosis. Poor outcomes are often pre-dated by reduced fetal movements but are not associated with ultrasound changes. In some cases, there has also been maternal thrombocytopenia, or coagulation abnormalities, which may provide a clue as to which pregnancies are at risk of fetal demise if a further variant of concern is to emerge. In future, multidisciplinary collaboration and cross-boundary working must be prioritised, to identify quickly such a phenomenon and provide clinicians with clear guidance for reducing fetal death and associated poor outcomes. While we wait to see if COVID-19 brings a future variant of concern, we must focus on appropriate future management of women who have had SARS-CoV-2 placentitis. As a placental condition with an infectious aetiology, SARS-CoV-placentitis is unlikely to recur in a subsequent pregnancy and thus a measured approach to subsequent pregnancy management is needed.

Risk of thrombocytopenia in neonates of thrombocytopenic mothers.

Maternal thrombocytopenia during pregnancy may occur due to several possible etiologies, with potential neonatal impact. The aim of the present study was to investigate whether there is a correlation between maternal and neonatal platelet count among women with thrombocytopenia during pregnancy. A cross-sectional retrospective study (2012-2019) was conducted at a tertiary medical center. Complete blood count was routinely measured in all patients on admission to the delivery ward. Thrombocytopenia was defined as a platelet count below 150 K/μL. Clinical and outcome parameters of thrombocytopenic mothers and their newborns were collected from the electronic files and analyzed by severity of maternal thrombocytopenia. Of 45 385 women with a documented platelet count at admission, 2841 (6.24%) had thrombocytopenia: 2623 (5.7%) mild (100-149 K/μL), 207 (0.45%) moderate (50-99 K/μL), and 11 (0.02%) severe (<50 K/μL). Eight newborns had thrombocytopenia; corresponding rates by severity of maternal thrombocytopenia were 0.11%, 1.43%, and 18.18% (P = 0.04). None of the thrombocytopenic neonates had an intraventricular hemorrhage or other bleeding complications. The correlation between maternal and neonatal platelet counts was weak (Pearson r = 0.038; P = 0.046). We suggest that although the chances of neonatal thrombocytopenia are higher with worsening maternal thrombocytopenia, actual occurrence is rare, and the correlation is poor. Therefore, maternal thrombocytopenia cannot be regarded as a significant risk factor for neonatal thrombocytopenia. Neonatal platelet count should be obtained when maternal thrombocytopenia is autoimmune or less than 100 K/μL.

Platelet Count Response to Obstetrical Use of IVIG for Maternal Thrombocytopenia: A 14-Year Retrospective Study

Introduction: Thrombocytopenia affects approximately 10% of pregnant individuals with Gestational Thrombocytopenia (GT) accounting for 80% of cases and Immune Thrombocytopenia (ITP) representing 3% of cases. Distinguishing between GT and ITP is challenging, leading to many pregnant individuals with moderate thrombocytopenia receiving treatment for ‘possible ITP’ with Intravenous Immunoglobulin (IVIG) in attempt to raise platelet counts (PLT) for safe labor and delivery and to potentially allow for neuraxial anesthesia. However, evidence on the impact of IVIG on PLT during pregnancy remains limited, and predictive factors for IVIG response are lacking. We aim to investigate the effect of IVIG on PLT in pregnant individuals with moderate thrombocytopenia (PLT &amp;lt; 100 x 10 9/L). The specific objectives are to assess the incremental response in maternal PLT following IVIG administration, the proportion of PLT exceeding 80 x 10 9/L after IVIG administration, the proportion of incremental increase in PLT by more than 20 x 10 9/L following IVIG administration, and to identify factors associated with these outcomes. Methods: We conducted a retrospective cohort study using administrative and chart review data between 2007-2020. We included all pregnant individuals who received IVIG for moderate thrombocytopenia. Data collected encompassed parameters such as age, gestational age at delivery, platelet counts at various timepoints, highest immature platelet fraction (IPF) during pregnancy, IVIG dose and frequency, hemoglobin levels, transfusions, and corticosteroid use. Data were analyzed using descriptive statistics. Paired t-test was used to compare means of PLT pre- and post-IVIG administration. Simple logistic regression was used to assess predictors of PLT ≥ 80 x10 9/L and PLT increment ≥ 20 x10 9/L post-IVIG. Results: Out of 651 deliveries with moderate thrombocytopenia, 79 (12.1%) received IVIG for a total of 4,527.50 grams and a median dose of 60 g (IQR: 30 - 77.5). Excluding 22 pregnancies due to other interventions such as platelet transfusions (n=12), corticosteroids (n=7), or both (n=3), 57 remained for analysis. The median incremental response in PLT following IVIG administration was 27 x10 9/L (IQR: 3-94). Pre-IVIG PLT median was 65 x10 9/L (IQR: 48-73), and post-IVIG PLT median was 98 x10 9/L (IQR: 69-142). PLT increment ≥ 20 x 10 9/L following IVIG was observed in 54.4% (31/57) of deliveries, and 57.9% (33/57) of deliveries achieved PLT ≥ 80 x 10 9/L following IVIG administration. Mean PLT post-IVIG (M = 112.51 x10 9/L, SD 55.88) were significantly greater than pre-IVIG PLT (M = 59 x10 9/L, SD = 19.71) by 53.51 points, p = &amp;lt; .001. Nadir PLT &amp;lt; 30 in pregnancy was associated with a statistically significant increase in PLT ≥ 80 x10 9/L following IVIG (odds ratio (OR) = 6.29, 95% confidence interval (CI) = 1.25-31.51, p &amp;lt; 0.05) and PLT increment ≥ 20 x10 9/L (OR = 7.58, 95% CI = 1.51-38.05, p &amp;lt; 0.05). An IPF &amp;lt; 16% was also associated with a statistically significant increase in PLT ≥ 80 x10 9/L (OR = 4.85, 95% CI = 1.08-21.76, p &amp;lt; 0.05) and PLT increment ≥ 20 x10 9/L (OR = 4.85, 95% CI = 1.08 - 21.76, p &amp;lt; 0.05). Moreover, a post-IVIG PLT increment ≥ 20 x10 9/L was positively associated with pre-IVIG PLT below 50 x10 9/L (OR = 8.67, 95% CI = 1.73 - 43.33, p &amp;lt; 0.05), but negatively associated with PLT 70-100 x10 9/L (OR = 0.18, 95% CI = 0.05 - 0.57, p &amp;lt; 0.05). For post-IVIG PLT ≥ 80 x10 9/L, there were no statistically significant relationships with gestational age, maternal age, pre-pregnant PLT or pre-IVIG PLT. Similarly, for post-IVIG PLT increment ≥ 20 x10 9/L, there were no statistically significant relationships with GA, maternal age, pre-pregnant PLT, or a pre-IVIG PLT between 50-69 x10 9/L. Conclusions: IVIG administration shows promising results for pregnant individuals with moderate thrombocytopenia. The study highlights the importance of nadir PLT in pregnancy, IPF levels, and pre-IVIG PLT as potential factors influencing the response to IVIG treatment. Our study is limited by its retrospective and single-centered design, and small sample size. Nevertheless, these findings generate hypotheses and could inform future prospective multicenter studies to optimize IVIG administration in this setting, considering its effectiveness and potential risks while minimizing costs.

Severe maternal thrombocytopenia and prenatal invasive procedures: still a grey zone.

Management of severe thrombocytopenia, particularly of ITP, in pregnancy is mainly based on expert consensus and clinical experience while there are no clear indications about the minimum platelet count requested for prenatal diagnosis invasive procedures. Since the lack of specific recommendations we reported our clinical management of a patient suffering from severe thrombocytopenia, undergoing amniocentesis. Due to the anecdotic possibility of maternal and fetal bleeding in case of severe thrombocytopenia, prophylaxis with IVIG or even corticosteroids could be considered as a safer strategy to prevent post-procedural adverse outcomes.

Case series of gestational thrombocytopenia

The antepartum diagnosis of maternal thrombocytopenia has become more common because platelet counts are now routinely obtained as a part of prenatal screening. We are reporting three cases of gestational thrombocytopenia, diagnosed clinically, admitted, evaluated and managed. Two cases reverted back to their normal status soon after delivery. Case one who presented as gestational thrombocytopenia was diagnosed as Immune thrombocytopenic purpura (ITP) and is on treatment and platelet monitoring even after delivery. Commonest platelet deficiency seen in obstetrics is Gestational thrombocytopenia which is 80%, but other underlying causes must be considered as well. A thorough history and physical examination rules out most causes. There is a positive correlation between thrombocytopenia with adverse fetomaternal outcome. Hence serial platelet monitoting should be done.

Neonatal Implications of Maternal Thrombocytopenia during Pregnancy.

Neonatal Implications of Maternal Thrombocytopenia during Pregnancy.

MATERNAL AND FOETAL OUTCOMES IN PREGNANCY WITH GESTATIONAL THROMBOCYTOPENIA: A PROSPECTIVE OBSERVATIONAL STUDY

Thrombocytopeniaissecond to anaemia as the most common hematological abnormality during pregnancy. Accurate etiological diagnosis is essential for optimal therapeutic management and thus can prevent maternal and fetal morbidity and mortality. Aim &amp;Objective:To study the clinical profile, maternal and perinatal outcomes in thrombocytopenic antenatal patients. Design:This Prospective observational study design was carried out in the department of obstetrics and gynecology at Chalmeda Anand Rao Institute of Medical sciences Karimnagar, over a period of 18 months from October 2020 to April 2022. Materials And Methods:All the pregnant women who attended antenatal OPD at Chalmeda Anand Rao Institute of Medical Sciences were tested for thrombocytopenia. 70 pregnant women with thrombocytopenia, platelet count lessthan 150x 109 /L and 70 pregnant women with normal platelet count were recruited into the study and the maternal &amp; Fetal outcomes of both groups were studied and compared. Results: Gestational thrombocytopenia is the most common etiology (57.1%). Incidence of thrombocytopenia due to severe preeclampsia and Hemolysis, Elevated Liver enzymes, Low Platelet (HELLP) syndrome in the study group was 28.5% and 8.5% of them had medical cause like malarial or dengue fever. Major causes were gestational thrombocytopenia (GT), Idiopathic Thrombocytopenic Purpura (ITP), Preeclampsia, HELLP syndrome, Malaria, and Dengue. Maternal complications due to bleeding tendencies like placental abruption, Postpartumhemorrhage were evident in the study population. Fetal complications were significantly higher in the study group. Early neonatal thrombocytopenia depended on etiology rather than severity of maternal thrombocytopenia. Conclusions:Outcome of pregnancy with moderate to severe thrombocytopenia dependsmainly on the etiology of thrombocytopenia. Adverse outcomes are especially seen with pregnancy complicated by preeclampsia and HELLP syndrome. Fetomaternal outcome is favorable in gestational thrombocytopenia. Thus, accurate etiological diagnosis is essential for optimal therapeutic management.

Intrauterine Spontaneous Subdural Hematoma with Hydrocephalus

Abstract Subdural hematoma in newborn baby is associated with history of maternal trauma, complicated vaginal delivery, instrumental delivery, foetal / maternal thrombocytopenia, coagulopathy, hepatic disease, infection or using drugs during the pregnancy; but in the absence of the above, intrauterine subdural hematoma is a rare event. We present a newborn delivered to a healthy mother at 38 weeks by elective caesarean section after he had been diagnosed with macrocephaly by routine obstetric growth scan ultrasound at 35 weeks of gestational age. The baby’s APGAR score was 4 at 1 minute, he was pale, his fontanel was tense and his Occipitofrontal circumference (OFC) was 46 cm, therefore, he was intubated immediately and transferred to Neonatal Intensive Care Unit (NICU). Brain Computed tomography (CT –scan) revealed huge right sided subacute subdural hematoma that was almost occupying the entire right hemicranial space and severely compressing the underlying brain tissue. In addition, there was marked dilatation of the left lateral ventricle with blood clots at the occipital horn. Subdural hematoma was evacuated by two burr holes surgery, followed by repeated subdural tap. Intraventricular haemorrhage treated by repeated ventricular tap until Cerebrospinal Fluid (CSF) became clear, then ventriculoperitoneal shunt surgery was done for him. Keywords: Subdural hematoma, Newborn, Hydrocephalus, Burr hole, Shunt surgery.

Maternal thrombocytopenia due to inflammatory changes in the placenta precedes fetal death associated with COVID-19

Maternal thrombocytopenia due to inflammatory changes in the placenta precedes fetal death associated with COVID-19

Severe autoimmune thrombocytopenia in a neonate secondary to maternal immune thrombocytopenia: a case report

&lt;p&gt;Neonatal thrombocytopenia is one of the common haematological problems encountered in neonatal intensive care unit. Severe neonatal thrombocytopenia is defined as a platelet count &amp;lt;50×10&lt;sup&gt;3&lt;/sup&gt;/µl and is relatively uncommon. Based on the time-of-onset, neonatal thrombocytopenia can be categorized into early-onset (&amp;lt;72 h after birth) and late-onset (&amp;gt;72 h after birth) thrombocytopenia. Neonatal autoimmune thrombocytopenia should be considered in any neonate who has early-onset thrombocytopenia and a maternal history of either immune thrombocytopenia (ITP) or an autoimmune disease (with or without thrombocytopenia). A term male baby, born to a 23-year-old primi-gravida with ITP was found to be thrombocytopenic at birth (platelets-85×10&lt;sup&gt;3&lt;/sup&gt;/µl) without any sign of neonatal sepsis. On serial monitoring, platelet counts kept falling and on day 3, the child developed severe thrombocytopenia (platelets-6.5×10&lt;sup&gt;3&lt;/sup&gt;/µl). No obvious signs of bleeding were present and the child was clinically well. Given the history of maternal thrombocytopenia (likely ITP), a possibility of neonatal autoimmune thrombocytopenia was considered. Owing to the risk of massive bleed, the baby was transfused random donor platelets and intravenous immunoglobulin (IVIg) was started on day 3. Thereafter, the platelets showed an increasing trend and child was discharged on day 7 with a platelet count of 170×10&lt;sup&gt;3&lt;/sup&gt;/µl. However, on follow-up platelet count was again found to be low (84×10&lt;sup&gt;3&lt;/sup&gt;/µl). It normalised subsequently, without any further requirement of IVIg. High index of suspicion, immediate work-up and diagnosis, with close monitoring and prompt management is required to prevent hemorrhagic complications in such children. Counselling for risk of thrombocytopenia in future pregnancies should be provided to parents.&lt;/p&gt;

Diagnostic Ideas and Management Strategies for Thrombocytopenia of Unknown Causes in Pregnancy.

ObjectiveTo summarize the clinical characteristics and treatment options together with the maternal and neonatal prognoses in women with different degrees of thrombocytopenia of unknown causes during pregnancy.Materials and MethodsOne hundred twenty-nine cases meeting the inclusion and exclusion criteria were retrospectively analyzed. Patients were divided into group A (50*109/L) and group B (50*109/L to 100*109/L) according to the lowest level of platelet count during pregnancy. Patients were divided into those found to have thrombocytopenia in the relatively early, middle, and late stages according to the detection period of maternal thrombocytopenia during pregnancy.ResultsThere were 72 cases in group A, and 57 cases in group B. There existed statistically significant differences in terms of the proportion of primipara, the proportion with a history of thrombocytopenia, and the median length of pregnancy between the two groups (p < 0.05). The proportion of patients with severe thrombocytopenia as an indication for cesarean delivery was higher in group A than in group B (p < 0.05). More cases were detected at the relatively early stages of pregnancy in group A than in group B (p < 0.05). There was no difference in neonatal hemorrhage and events of thrombocytopenia between the two groups.ConclusionPatients with platelet counts below 50*109/L were mostly primipara with a history of thrombocytopenia, most often detected at a relatively early stage of pregnancy, and continued pregnancy might lead to aggravation of the disease. Combination therapy was required for patients with platelet counts below 30*109/L to maintain the platelet counts within a safe range. Cesarean delivery was selected to terminate the pregnancies, and platelet counts should be raised above 50*109/L before surgery. Close monitoring was required for those with platelet counts above 30*109/L. There was no direct correlation between the maternal and neonatal platelet counts.

A Study of Maternal and Fetal Outcome of Thrombocytopenia in Pregnancy

Background: Thrombocytopenia is found to complicate pregnancies in India. The major function of platelets is the initiation of haemostasis. Thrombocytopenia can result in spontaneous bleeding from any part of the body. It may be associated with serious bleeding at delivery and may require emergent maternal and neonatal care. Introduction: After anaemia, thrombocytopenia is the most frequently occurring hematologic disorder in pregnancy. It is found to complicate 7% to 8% of pregnancies in India. The major function of platelets is the initiation of haemostasis, and hence, thrombocytopenia can result in spontaneous bleeding from any part of the body. It may be associated with serious bleeding at delivery and may require emergent maternal and neonatal care. Thrombocytopenia is diagnosed if the platelet count 150 × 109/l, caused by increased platelet lysis or reduced inefficient production. Aims &amp; Objectives: To study the maternal and fetal outcome of thrombocytopenia in pregnancy and to study some of the causes of thrombocytopenia in pregnancy. Methodology: Total 113 cases with maternal thrombocytopenia were included in present study after satisfying inclusion and exclusion criteria and followed till delivery. We studied maternal complications gestational age at delivery, indication of induction of labour and method (if required) and mode of delivery, NICU stay were recorded. Results: Majority of the patients i.e. 63 patients (55.8%) were in the age group of 20-25 years. Among 113 cases; primigravida (56 cases, 49.6%) and multigravida (57 cases, 50.4%) were almost equally distributed. Majority of the study population was diagnosed with Gestational thrombocytopenia 50.4% followed by severe pre-eclampsia 22.12%, HELLP syndrome 8.8%, abruption 5.3% antepartum eclampsia and dengue 2.7% each. Maternal mortality was seen in 2 cases (1.8%). Mean birth weight was found to be 2.45 Kgs. of 113 babies, neonatal mortality was seen in 15 cases, NICU admission was indicated in 18 babies and KMC care was needed for 1 baby. Conclusion: The most common cause of thrombocytopenia during pregnancy is Gestational Thrombocytopenia (GT) followed by pre-eclampsia, eclampsia and HELLP syndrome. With platelet counts above 70,000/ μLno prior history of thrombocytopenia the condition is more likely to be GT. The lack of well-defined symptomatology and clinical presentation makes early and accurate diagnosis difficult leading to delay in treatment.

Fetal Deaths in Ireland Due to SARS-CoV-2 Placentitis Caused by SARS-CoV-2 Alpha.

A severe third wave of COVID-19 disease affected Ireland in the first 3 months of 2021. In this wave, 1 second-trimester miscarriage and 6 stillbirths were observed in the Irish population because of placental insufficiency as a result of SARS-CoV-2 placentitis. This observation was at odds with the country's previous experience with COVID-19 disease in pregnant mothers. To describe the clinical and pathologic features of these pregnancy losses. Retrospective review of clinical and pathologic data of cases of second-trimester miscarriage, stillbirth, or neonatal death identified by perinatal pathologists as being due to SARS-CoV-2 placentitis during the third wave of COVID-19 in Ireland. Clinical and pathologic data were available for review in 6 pregnancies. Sequencing or genotyping of the virus identified SARS-CoV-2 alpha (B.1.1.7) in all cases. Three of the 6 cases had maternal thrombocytopenia, and fetal growth restriction was not prominent, suggesting a rapidly progressive placental disease. The identification of SARS-CoV-2 alpha in all these cases suggests that the emergence of the variant was associated with an increased risk of fetal death due to SARS-CoV-2 placentitis when compared with the original virus. Maternal thrombocytopenia may have potential as a clinical marker of placentitis, but other inflammatory markers need investigation. Three of the 6 women had been assessed for reduced fetal movements in hospital some days before the fetal deaths actually occurred; this could suggest that there may be a window for intervention in some cases.

Prevalence of maternal thrombocytopenia and anaemia in pregnant woman - An institutional experience

Prevalence of maternal thrombocytopenia and anaemia in pregnant woman - An institutional experience

Vancomycin-related thrombocytopenia in neonates

Background With the improvement of neonatal care in the country and survival of the preterm infants and sick neonates, many arising problems are being observed. One of these is the significant presence of neonatal thrombocytopenia and the need for lots of platelet transfusions per an infant. Many neonatal factors can cause thrombocytopenia, but we observed severe, prolonged thrombocytopenia in infants who received specifically vancomycin for sepsis or other medical/surgical conditions. Literature search revealed that vancomycin can cause immune thrombocytopenia by inducing platelet antibodies, though this is scarcely described in neonates. Participants and methods This is a hospital-based longitudinal study held in NICU during February 2017 to February 2019. All admitted neonates (term and preterm) who received vancomycin were involved, but those with maternal thrombocytopenia, systemic lupus erythematosus (SLE), maternal eclampsia/HELLP (Haemolysis, Elevated Liver enzymes, Low Platelets) syndrome, and Intr Uterine Growth Rrestriction (IUGR) were excluded. Results Of 117 infants admitted in this period, 68 infants fulfilled the inclusion criteria. The severe decline in platelet count observed on the second to third day of vancomycin treatment continued throughout the treatment and started to rise 2–3 days after discontinuation. During treatment with vancomycin, platelet transfusion 2–3 times a day was observed not to raise platelet level significantly, but it prevented serious bleeding. Conclusion Vancomycin-induced thrombocytopenia in neonate is a rising new problem in NICUs. The authors may need to add adjunctive intravenous immunoglobulins or methylprednisolone or change the dosing system to smaller frequent doses, given over longer time, to overcome this serious problem.

Thrombocytopenia in pregnant women.

Thrombocytopenia is one of the two most common hematological problems in pregnant women. It is defined as the platelet (PLT) count below 150 × 103/μL. Gestational incidental thrombocytopenia (GIT) represents about 75% of thrombocytopenia cases in pregnancy and it is believed that GIT is secondary to accelerated platelet destruction and increased plasma volume associated with pregnancy. The pregnancy complications such as preeclampsia and its most severe form - HELLP syndrome account for 20% cases of thrombocytopenia in pregnancy and primary immune thrombocytopenic purpura (ITP) - for 3-4 percent. During ITP, maternal antiplatelet antibodies can pass through the placenta and bind to fetal thrombocytes leading to the development of fetal thrombocytopenia which occurs in about 50% cases. Even if the maternal platelet count stabilizes, the estimated fetal and neonatal risk of thrombocytopenia in ITP is approximately 30%. Other types of thrombocytopenia in pregnant women constitute 1-2% of cases (disseminated intravascular coagulation, autoimmunological diseases, congenital, infection and drug-related, concomitant with blood neoplastic diseases). Although thrombocytopenia in pregnant women usually has a mild course, in case of a significant decrease in PLT count may lead to dangerous bleeding, especially when the platelet count falls below 20 × 103/μL. Since it is important to identify the cause of thrombocytopenia and to determine the risk for both the mother and the child, this paper presents the influence of maternal thrombocytopenia on the pregnancy course as well as its etiology and diagnostics. The treatment principles are discussed.

Thrombocytopenia during pregnancy and its outcome- A prospective study

Thrombocytopenia is the second most common haematological finding in pregnancy after anaemia. Thrombocytopenia is defined as decrease in platelet count &amp;#60; 1,50,000/µL. The physiological thrombocytopenia of pregnancy is mild and has no adverse effects on mother and foetus whereas thrombocytopenia associated with medical conditions can have serious maternal-foetal consequences and needs specific monitoring and appropriate management. : The aims of the study were to evaluate causes of thrombocytopenia in pregnancy and to study clinical profile, maternal and perinatal outcome in thrombocytopenic antenatal patients after 28 weeks.: Aprospective study was conducted in department of Obstetrics and Gynaecology and department of Pathology at Government Medical College and Rajendra Hospital, Patiala.100 antenatal females were included in the study with platelet count &amp;#60;1,50,000/µL and period of gestation more than 28 weeks. The subjects were investigated after detailed history and examination. Maternal and foetal outcomes were observed in all cases.Out of 100 subjects with thrombocytopenia, 33% had gestational thrombocytopenia, which was the most common cause; followed by preeclampsia/eclampsia (24%). 18% subjects had severe thrombocytopenia. Complications were seen in the form of HELLP (6%), ICU admission (3%), PPH (3%), Puerperal sepsis (1%). Maternal thrombocytopenia due to medical causes needs strict observation and timely intervention for favourable maternal and perinatal outcomes.

Clinical profile of thrombocytopenia in pregnancy

Thrombocytopenia is defined as platelet count of less than normal for the laboratory. This typically is at or very close to1.5 lakh/cumm. Hence platelet count of less than 1.5 lakh/cumm is called as thrombocytopenia. Thrombocytopenia in pregnancy is not an uncommon finding; in fact, it is the second most common hematological disorder in pregnancy after anaemia and affects nearly 6 to 15%; on an average 10% of all pregnancies. The reported prevalence of maternal thrombocytopenia is variable. In a recent survey in 2000 involving 6770 pregnant women, prevalence of thrombocytopenia was found to be 11.6%. A prospective observational study conducted to identify causes for thrombocytopenia in pregnancy along with its neonatal outcome Out of total, 30% patients delivered low birth weight babies and 70% delivered babies with birth wt of >2.5kg. Occurrence of low birth weight babies in mothers with GT and ITP were comparable being 27.3% and 33.3% respectively. APGAR score (at 1 min) of neonates was less than 7 in 12% neonates while at 5 min it was below 7 in only 1(2%) baby. Neonates born to mothers with ITP had poor 1 minute APGAR score when compared to neonates born to patients with GT. There was no significant relationship found between maternal and fetal platelet counts in patients with gestational thrombocytopenia. ITP leads to neonatal thrombocytopenia. Keywords: Cord blood, Thrombocytopenia, APGAR scoring, ITP, Gestational thrombocytopenia.