Associations between Severity of Thrombocytopenia & Pregnancy Induced HTN in a Tertiary Care Hospital: An Observational Study

Author(s): Dr. Kazi. Mst Sadeka Tamanna, Dr. Fatema Akter Doly, Dr. Imran Mahmud, Dr. Khadiza Khan Toma, Dr. Farzana Mahmood.

Background:

Hypertension is a common complication of pregnancy and contributes significantly to maternal and perinatal morbidity and mortality. Without intervention, pregnancy-induced hypertension can progress to eclampsia, which is characterized by hypertension, proteinuria, edema and convulsions requiring immediate termination. Thrombocytopenia is one of the remarkable haematological changes that occur during pregnancy and, at times, is life-threatening. Therefore, platelet count can be used as an early, simple, and rapid test to assess the severity of pre-eclampsia and prevent progression to HELLP syndrome and DIC.

Aim of the study:

The study aims to find out the association between the severity of thrombocytopenia and pregnancy hypertension

Methods:

This observational study was conducted at the Dhaka Medical College Hospital from April 2018 to June 2019. The calculated sample size was 384, but due to time constraints and less availability of pregnancyinduced hypertensive patients, 65 patients attending the OBS & GYN department for delivery purposes were included in the study. After getting informed consent, all the subjects underwent blood investigations, i.e. complete blood cell count for Platelet count using EDTA anticoagulant blood and analyzed on Mindray, Automated Hematology Analyzer”.

Result:

Out of 65 pregnancy-induced HTN patients, 29% had Gestational HTN, 8(12.3%) were suffering from mild pre-eclampsia, and 22(33.85%) were having severe pre-eclampsia. Sixteen patients had eclampsia. Among all of the study subjects, 27 had thrombocytopenia with further fragmentation as mild thrombocytopenia (40.5%), moderate thrombocytopenia (40.5%), severe thrombocytopenia (19%), and the rest 38 had normal platelet counts. Twenty per cent in the age group of 21- 25 years were having thrombocytopenia. Out of 65 pregnancy-induced hypertension patients, 32(49%) were prim gravida, and 30 (46%) were multigravida. Three patients suffered from postnatal pregnancy-induced hypertension. Fourteen out of 32 prim gravida cases had thrombocytopenia in varying degrees. Twelve of 30 multigravida subjects suffered from thrombocytopenia. Fifty-six per cent of patients had elevated liver enzymes. Maternal morbidity with thrombocytopenia was 13.8%, whereas overall foetal morbidity was 31%. Maternal mortality was found to be 4%, all of which were associated with severe thrombocytopenia, whereas overall foetal mortality was calculated to be 26%

Conclusion:

This study and the results show that the assay of platelets can be considered as one of the early, simple, and rapid tests to assess the severity of pre-eclampsia and prevent progression to further complication