Nghiên cứu đặc điểm lâm sàng, cận lâm sàng, thái độ xử trí với thai phụ giảm tiểu cầu trong thai kỳ tại bệnh viện phụ sản trung ương TT TIENG ANH

MINISTRY OF EDUCATION

MINISTRY OF HEALTH

AND TRAINING
HANOI MEDICAL UNIVERSITY

DAO THI THANH HUONG

INNITAL STUDY ON CLINICAL FEATURE,
LABORATORY AND TREATMENT BEHAVIOR IN
PREGNANCY WOMEN WITH
THROMBOCYTOPENIA

Speciality
Code

: Obstetrics and Gynaecology
: 62720131

PH.D. THESIS SUMMARY

HANOI - 2022


THE THESIS WAS FULFILLED AT
HANOI MEDICAL UNIVERSITY

Principal Supervisors:

Prof. Dr.Tran Danh Cuong

Prof. Dr.Le Xuan Hai

Opponent 1:

Opponent 2:

Opponent 3:

The thesis will be defended at Board of Examiners of Hanoi
Medical University At: 14:00 Date: 10/ 09 / 2022

The thesis can be found at:
- National Library
- Hanoi medical University Library


LIST OF RESEARCH WORKS PUBLISHED RELATED
TO THE THESIS

1.

2.

3.

4.

5.

6.

Đao Thi Thanh Huong (2015). “A case report on the
thrombocytopenia in pregnancy and newborn. Journal of Obstetrics and
Gynecology; volume 13(01), 05-2015, page 74-76
Đao Thi Thanh Huong (2015). “Comments on management during
labor for pregnancy with indopathic thrombocytopenia in the
National hospital of Obstetrics and Gynecology 2012”. Journal of
Obstetrics and Gynecology; volume 13(02), 05-2015, page 86-88.
Đao Thi Thanh Huong, Tran Danh Cuong (2016). “Clinical,
characteristics, subclinical, access management for thrombocytopenia
pregnancy during labor in the National hospital of Obstetrics and
Gynecology 2015”. Journal of Obstetrics and Gynecology; volume
14(01), 05-2016, page 56-60
Đao Thi Thanh Huong, Tran Danh Cuong (2017). “Impact of
maternal thrombocytopenia in pregnancy to neonates”. Obstetrics and
Gynecology; volume 15(02), 05-2076, page 70-74.
Đao Thi Thanh Huong, Tran Danh Cuong (2015). “Clinical,
characteristics,
subclinical,
access
management
for
thrombocytopenia pregnancy during labor in the National hospital
of Obstetrics and Gynecology 2014-2015”. Doctor of Philosophy
students meeting, page 160-161.
Đao Thi Thanh Huong, Tran Danh Cuong, Le Xuan Hai (2020).
“Impact of maternal thrombocytopenia in pregnancy to neonates”. Việt
Nam medical journal; volume 496, page 510-513

1
INTRODUCTION
Thrombocytopenia is one of the causes leads to postpartum bleeding even
maternal and neonatal mortality due to hemostasis disorder. Thrombocytopenia
is caused not only by medical condition but also by pregnancy.
Thrombocytopenia in pregnancy includes: 70-80% due to pregnancy
(gestational thrombocytopenia), 20% due to preeclampsia /eclampsia, HELLP
(Hemolysis: hemolysis, EL (elevated liver enzymes), LP (low platelet count)
and about 3-4% immune thrombocytopenia.
Gestationalthrombocytopenia(GT)is themost common cause of
thrombocytopenia during pregnancy. Platelet value is usually above 80G/l and
returns toal levelwithin the first three months postpartum. The pathophysiology
of gestational thrombocytopenia is unknown, but it might relate to increased
blood volume during pregnancy. The diagnosis is sometimes made after having
a test result. The treatment of thrombocytopenia in pregnancy is complicated
due to maternal and fetal safety concerns and having a tough choice between
the intervention or followup monitoring.
Thrombocytopenia in pregnancy has been mentioned since the 1980s
around the world. Many researches on the management of thrombocytopenia in
pregnancy during delivery and the follow up monitoring of newborns have
been done. The relationship between maternal conditions and the degree of
fetal thrombocytopenia has been also assessed and this matter remains
challenging to obstetricians. In Vietnam, there have been few studies on
thrombocytopenia, therefore this study is set to explore:
1. Clinical and subclinical characteristics of pregnant women with
thrombocytopenia.
2. The management of thrombocytopenia in pregnancy.
3. Estimation of hematologic value of new-borns whose mothers diagnosed
with thrombocytopenia during pregnancy.
New contributions from the thesis

 This is the first thesis in Vietnam to access the effect of pregnant
thrombocytopenia to the number of thrombocytes in newborns whose mothers
are diagnosed with thrombocytopenia in pregnancy.
 This study gives initial insight on the difference of thrombocytopenia in
pregnancy and ITP.
 This study also is the first study in Vietnam, which uses antiplates
antibodies test in pregnant women and newborns. In addition, antiplates
antibodies test is screened by flow cytometric.
Thesis outline.
The thesis consists of 145 pages, covering: introduction (2 pages), overview (35
pages), object and method of research (19 pages), results (34 pages), discussion (52
pages), conclusion (2 pages), proposal (1 page). It has 34 tables, 12 figures, 12 charts.
163 Referecnce, including English and Vietnamese versions.


2
Chapter 1
OVERVIEW
1.1. Platelet

Figure 1.1.Diagram of platelet growth and maturation
1.2. Thrombocytopenia and the causes
1.3. Thrombocytopenia in pregnancy
Thrombocytopenia in pregnancy is caused by medicine conditions or decreased
platelet count associated with pregnancy.
The main causes of it relating to pregnancy are gestational thrombocytopenia
(75%), the secondary diseasesdue to hypertensive and immune disorder in
pregnant women. Other causes such as preeclampsia, HELLP syndrome, acute
fatty liver of pregnancy, disseminated intravascular coagulation, im-mune
thrombocytopenic purpura, and hemolytic uremic syndrome may be founded

based on clinical and laboratory abnormal findings. Furthermore,
thrombocytopenia can also be as a manifestation of viral infections or adverse
effects related to drugs and supplements and it requires careful differential
diagnosis by history and laboratory tests. Nevertheless, ITP that first appears in
pregnancy is often confused with gestational thrombo-cytopenia in a clinical
setting. In case of asymptomatic thrombocytopenia for the first time of
pregnancy, lumbar puncture procedure is not routine. Hematologist and
obstetrician distinguish ITP from GT by the onset time and platelet count.
1.3.1 Gestational thrombocytopenia
In pregnancy, there is significant physiological changes in the body of mothers
for adaptation and being able to provide nutrition sufficiently to fetus. In terms
of hematological system, plasma volume has increased, and coagulation factors
has changed. For the latter, these changes are mild thrombocytopenia, an
increase in coagulation factors and decrease in fibrinogen.
1.3.2 Immune thrombocytopenic purpura
The pathophysiology of ITP is autoimmune mechanism. It is demonstrated that
the lifespan of intravascular platelet of ITP is shortened and primary
mechanism is the platelet destruction in peripheral tissue. Even nowadays,
initial factors producing anti-platelet antibodies are still unknown, but it is the
fact that antiplatelet antibodies from lymphocyte B is specificallyresponded to
glycoprotein in platelet membrane and theyweredestroyed by macrophages or


3
dendritic cells in the liver and spleen via receptor Fcy. Activated cytokine like
IL-2 results in lymphocyte TCD4 proliferation (Th1, Th2). Lymphocyte
TCD4s stimulate lymphocyte B to produce anti-platelet glycoprotein
antibodies.
1.3.3
Neonatal thrombocytopenia (NT)

Neonatal thrombocytopenia is not caused by thrombocytopenia in pregnancy,
but it could be by ITP with antiplatelet antibodies passing through placental
barrier (IgG). It is the standard of diagnose of GT or immune
thrombocytopenia. Nevertheless, not all cases of ITP cause neonatal
thrombocytopenia.
Hemorrhage in NT are the common immune pathologies. This disease is
characterized by platelet in peripheral vascular destroyed in the
reticuloendothelial system associated with ant- platelet antibodies.
Although the correlation between the magnitude of platelet level decline and
the occurrence of neonatal thrombocytopenia is unfound, some studies show
that themoderate and server neonatal diseasesrelated to ITP mothers account
for 10% and 4%, respectively and the hemorrhage rate approx. 1%. Evaluation
of prenatal fetal platelet count through fetal blood sampling or fetal scalp blood
sampling is not routine due to the high rates of complications and fetal loss. In
clinical practice, the best predictable factor of neonatal thrombocytopenia is
based on the history of GT with thrombocytopenia of preceding infants.
1.4 Anti- platelet antibodies
1.4.1 Platelet Antigen
1.4.2 Platelet Antibodies
 Autoantibody
Autoantibodies is an antibody (immune proteins) that mistakenly targets and
reacts to a person’s own tissues or organs. One or more autoanti-bodies may be
produced by a person’s immune system that fails to distinguish between “self”
and “non- self”. Usually, when foreign substances infiltrate into body, for
example bacteria, viruses and parasite, the lymphocyte will produce antibodies
against them. In the autoimmune disease, the body mistakenly discriminate its
own organ as strange things and may produce antibodies reacting to its own
cells, tissues or organs.
 Anti- platelet alloantibody.
Alloimmunity is an immune response to non-self antigens from members of the

same species, commonly due to blood infusion or transplanted tissues
andpregnancy. The reaction is caused by the role of alloantibody HPA with
HPA1a antibody approximately 80% specific HPA anti platelet antibody.
Alloantibodies against HPAs and HLA is related to platelet disorders via
immune mediation. Hemorrhage in fetal immune thrombocytopenia is due to
fetal HPA that stimulates the immune system of mother and produces
antibodies against fetal platelet.


4
 The correlation between antiplatelet antibodies and thrombocytopenia
Now, anti-HPA antibody can be detectable by highly sensitive measures. However,
ani-HPA antibody evidence did not demonstrate that these antibodies led to
decrease in platelet count. In clinical practice, it is clearly important to determine
whether antibody leading to thrombocytopenia present or not. Few reports showed
that very low antibody titer may lead to declined platelet count in animal. There is
strong evidence that antibody may make platelet decrease, even the antibody level
is lower than the detectable limitones by common measures.
1.4.3.Antibody tests
Some measures such as available taget cell help to detect anti–HPA antibodies.
Common measures today are MAIPA-Monoclonal antibody-specific
immobilisation of platelet antigens, PAC-platelet antigen capture
immunoassay), MPHA-mixed passive haemagglutination), flwcytometry
analysis, ELISA, Luminex lab test. These attribute are abstracted in table.
Anti–HLA antibody may create problems with platelet antibody test, such as
MPHA and flow cytometry but, not specific test like MAIPA. MAIPA is
highly sensitive and specific, therefore, it is considered to golden standard.
CHAPTER 2
MATERIALS AND METHOD
2.1. Studyparticipants

This descriptive study was conducted at National Hospital of Obstetrics and
Gynacology in the period from March 2014 to December 2018. The study
protocol was approved by the Ethics Committee of Nation hospital for
Obstetrics and Gynecology. Informed written consent was provided from all
participants.
All participants was diagnosis with thrombocytopenia at one of the hospitals
including: National Hospital of Obstetrics and Gynecology, Bach Mai
Hospital, and National Institute of Haematology and Blood Tranfusion and
thier newborn.
2.1.1. Inclusion
Pregnant women included in the study had to fulfil all of the following criteria:
- Normal health history.
- Platelet counts is below 150G/l
- Not been diagnosed with thrombocytopenia due to bone marrow
failure, viral infection, cancers, or drugs,…
2.1.2. Exclusion criteria
Women were excluded if they: not end their pregnancy at National Hospital of
Obstetrics and Gynecology.
2.2. Setting and time
The study was conducted at all three hospitals include: National hospital of
Obstetrics and Gynecology, Bach Mai Hospital, and National Institute of
Haematology and Blood Tranfusion from March. 2014 to December 2018.


5
2.3. Study Method
2.3.1. Study Design
Descriptive study
2.3.2. Sample Size
We use non-probability sampling to collect those who met all the criteria. In

fact, 58 patients and their newborns were recruited into our study.
2.3.3. Data collection
+ Patients who met all the criteria will be chosen to our study
+ All of them will be examined thoroughly and carefully and have their blood
sample taken.
+ Haematological consultation to decide when we should terminate pregnancy
+ Pediatric consultation to decide
2.4. Variables
2.4.1 Basic characteristics of participants
+ Age: divided into aged groups: under 18 years old, 18-34 year-old group,
above 35 year-old group.
+ Career: officer, worker, farmer and others.
+ Parity: 1, 2 or more than 2
+ A history of thrombocytopenia in previous pregnancy: yes or no
+ Timing of thrombocytopenia diagnosed: ≤ 14-week gestation, 15-28 week
gestation, or ≥28 week gestation.
2.4.2 Clinical, subclinical characteristics and causes of thrombocytopenia
in pregnant women.
+ Haemorrhage: no symptom, cutaneous bleeding, mucosa bleeding, internal
bleeding.
+ Timing of haemorrhage: admission, before the termination of pregnancy, or
before discharge.
+ Haematological status: before the termination of pregnancy, or before
discharge.
+ Platelet count at the time of diagnosis.
+ Platelet count at the time of delivery.
+ Anti-platelet antibodies: negative or positive
+ The level of anemia:
+ Postpartum follow-up: yes or no.
2.4.3 The evaluation of neonatal hematological status whose mothers are

diagnosed with thrombocytopenia
+ Gestation
+ Weight
+ Platelet counts: <50G/l; 50-100 G/l; >100G/l
+ Anti platelet antibodies: positive or negative
2.4.4 Management of thrombocytopenia in pregnancy
+ Delivery: vaginal delivery, C – section


6
+ Analgesic methods:
+ Medicine: Corticoid
2.5. Assessment Criteria and Techniques
2.5.1 Assessment criteria.
2.5.2 Testing procedures for platelet antibodies
2.5.2.1. Principle
Human platelet antigens are presented on the surface of platelet cells.
Patients might produce platele antibodies when they are administered plalelet
transfusion(this type of antibodies partly attach to platelet surface or be free in
the blood serum). The nature of these antibodies is IgG, therefore we can detect
the antibodies which attach to platelet surface by using fluorescent antibodies
in Flowcytomater.
2.5.2.2. Sample
+Whole blood sample.
+ 2ml in blood collection tube containing EDTA
+Send blood sample to laboratory to refine serum by using 3000 cycle
centrifugal method.
+ Take serum out of the blood sample (300µl).
+ Preserve serum sample at 2-8℃
+ Serum samples are transferred to National Institute of Haematology and

Blood Tranfusion to do indirect anti-platelet antibodies test.
2.5.2.3 Assessment Criteria
+ Platelets which are refined should not contain erythrocytes and lymphocytes
+ Negative sample or O sample are takes from donors who never had a
platelets transfusion before.
+ Assess platelets base on SS and FS
+ Blood collection tube should be sterilized
+ The number of antibodies should be adequate.
+ The chemicals should not out of date
+ The timing for testing should be adequate.
2.6. Data analysis
+The statistical analyses were performed by using SPSS 22 package program
+ Categorical data were expressed as number and percentage. For qualitative
data, Chi-square test was used.
+ P<0.05 considered to be statistically significant.
2.7. Ethical consideration
This study was of a descriptive study and approved by the Ethics Committee of
Nation hospital for Obstetrics and Gynecology. Informed written consent was
provided from all participants.
The study aimed to early diagnosis thrombocytopenia in pregnancy to benefit
prophylaxis and early treatment. This study was not involved in any harmful
intervention or put patients in danger. The assessment of hematological status
is compulsory during pregnancy.


7
CHAPTER 3
STUDY RESULTS
3.1. The common characteristics of the patient in the study group
From April 2014 to April 2018, we conducted a blood test using the Sysmex

XT2000i and found 58 pregnant women with thrombocyto-penia with the
following common characteristics:
Average age of the study group is 28.6 ± 5.5 years (19-40 years old). The most
common age group is from 18-34 years old, accounting for 79.3%. The
majority of patients have professional staff is 25, accounting for 43%. The
proportion of farmers and workers is almost the same (24%; 23%). The number
of patients who had giving birth for the first time and which for the second
time that was the same (50.0%).
3.2. The clinical and paraclinical characteristics of studyparticipants
pantient
3.2.1. The gestational age when diagnostic of thrombocytopenia
Table 3.2. Patient distribution stratified by gestational age when diagnostic
of thrombocytopenia
Week age
Number
Rate (%)
≤ 14
5
8.6%
15-27
9
15.5%
≥ 28
44
75.9%
Total
58
100%
Comment: The mainly of thrombocytopenia was occurs in the third trimester
of pregnancy (75.9%), of which 8 pregnant women detected thrombocytopenia

during labor. The group of women in the first trimester was the lowest (8,6%).
The Averange gestational age in the study group was 30,2±7.8 (08-41 weeks).
The maximum: 41 weeks and the minimum: 08 weeks.
3.2.5. The reason for the thrombocytopenia was detected

Figure 3.3. Patient distribution stratified by the reason for the
thrombocytopenia was detected
Comment: The common cases are those who was detected for
thrombocytopenia mainly due to having their blood count test when they
check-up by their doctor (62.1%). The less common cases are those who
detected due to accidental testing (17.2%). The least cases are those who
detected due to hemorrhagic symptoms (only 6.9%: 4 patients).


8
3.2.7. Symptoms of hemorrhage
Table 3.7. Patient distribution stratified by symptoms of hemorrhage
Symptoms of hemorrhage
Number
Rate (%)
No
54
93.1
Yes
Skin
0
0.0
Soft tissue
4
6.9

Internal bleeds
0
0.0
Total
58
100.0
Comment: There are only 04 of 58 study patients (6.9%) had moderate
symptoms of bleeding (bleeding gums, nosebleed); no symptoms of severe
bleeding.
3.3.4. Comparison of platelet count in diagnosis and in labor
Table 3.8. Patient distribution stratified by platelet count in diagnosis and
that was in labor
In diagnosis
In labor
Maternal
platelet count
Number
Rate (%)
Number
Rate (%)
<50G/l
21
37.5
14
22.1
50-<100G/l
23
41.1
27
46.6

100- <150G/l
12
21.4
17
29.3
Total
56
100.0
58
100.0
79.07± 33.74 (14-158) G/l
65.7 ± 33.4(2-125) G/l
𝑥̅ ± SD
fisher's exact test p=0.033
Comment: The platelet count in labor was lower than that in diagnosis:
65.7±33.4G/l (2-125G/l) and 79.07 ± 33.74G/l (14-158G/l). In the group of
severe thrombocytopenia (<50G/l): this rate was decrease than that in diagnosis
(22.4% and 37.5%). In contrast, the rate of groups with mild and moderate
thrombocytopenia in labor that was increase (21.4%→29.3% and
41.1%→46.6%). This difference was significant (p <0.05).
3.3.5. The maternal anti-platelet antibodies

Figure 3.3. Patient distribution stratified by the maternal anti-platelet
antibodies
Comment: The rate of women with anti-platelet antibodies in the study group
for 31.0%. The thrombocytopenia subgroup regarding immune causes
accounted for 82.7% of total58 women. However, the percentage of positive
anti-platelet antibody tests in this subgroup was only 37.5%.

9
3.3.6. The maternal anaemia before and after delivery
Table 3.9. Patient distribution stratified bythe maternal anaemia before
and after delivery
Anaemia
Before delivery
After delivery
Number

Rate (%)

Number

Rate (%)

No (110g/l≤Hb)

46

79.3

26

51.0

Grade 1 (80g/l ≤ Hb<110g/l)

12

20.7

22

43.1

Grade 2 (60g/l≤Hb<80g/l)

0

0

3

5.9

Total

58

100

51

100

fisher's exact p=0.000, pair test p=0.000
Comment: The rate of maternal anaemia after delivery was 2 times more than
poir delivery (100% -79.3% = 20.7% compared with 100% -51.0% = 48.3%).
This rate was increases at all grades of anemia:grade1→grade2 (respectively:
20.7%→43.1%; 0%→5.9%). There was no pregnant woman with grade 3

anemia in both before and after delivery groups.This rate was the highest
increase in the grade 1 anemia subgroup. This difference was insignificant (p
<0.05).
3.2.14. Relationship between gestational age and the reason of diagnosis
thrombocytopenia
Table 3.11. Patient distribution stratified by gestational age and the reason
of diagnosis thrombocytopenia
Reason
Test
Check-up
Hemorrhage
Labor
Total
Age of gestational
n
%
n
%
n
%
n
%
≤14 week

3

60.0

1

15.0

1

15.0

0

0.0

5

15-27 week

2

22.2

5

55.6

2

22.2

0

0.0

9

≥28 week

5

11.3

30

68.2

1

2.3

8

18.2

44

8

58

Total

10

36

4

fisher's exact test p=0.010
Comment: In the first trimester of pregnancy, thrombocytopenia was detected
mainly due to screening and antenatal check-ups (60%). For the second
trimester and third trimester it was found by anteatal care and they got the
highest proportion(55.6% and 68.2%). This difference was insignificant
(p <0.05).
3.2.15. Relationship between gestational age and the maternal platelet count
in diagnosis


10
Table 3.12. Patient distribution stratified by gestational age and the maternal
platelet count
Maternal platelet count <50G/l 50-<100G/l
100 - <
Total
150G/l
n Rate
n
Rate
n Rate % n Rate %
Gestational age
%
%
≤14week (1st trimester)
3

75
0
0
1
25
4 7.14%
15-27week (2sd trimester) 3 33.33 3
33.33 3
33.33 9 16.07%
≥28 week
15 34.9 20
46.5
8
18.6 43 76.79%
Total
217.5
231.1
1221.4
56
fisher's exact test p=0.303
Comment: The ratio of thrombocytopenia diagnosis decreased accordingly to
gestational age (7.14%; 16.07%; 76.79%).
In the group of thrombocytopenia appearing from the first trimester of
pregnancy, the rate of severe thrombocytopenia was the highest more than the
other two groups (75%; 0%; 25%). However, in the group of the second
trimester, the rate of mild, moderate and severe was similar (33.33%; 33.33%;
33.33%).This difference no was insignificant (p >0.05).
3.2.23. Relationship between level thrombocytopenia in delivery and
maternal anti-platelet antibodies
Table 3.19. Patient distribution stratified by level thrombocytopenia in

delivery and maternal anti-platelet antibodies
Maternal platelet
50<50G/l
100-150G/l
Total
count
<100G/l
APA
n
%
n
%
n
%
n
%
4 22.2
8 44.5
6
33.3
18 100.0
Yes
28.6
29.6
35.3
31.0
1 25.0
1 47.5 11
27.5
40 100.0

No
0 71.4
9 70.4
64.7
69.0
Total
14
27
17
58
fisher's exact test p=0.352
Comment: There was18 out of 58 with anti-platelet antibodies test positive,
accounting for 31.0%. The rate of mild thrombocytopenia subgroup had the
highest proportion of antiplatelet antibodies test positive (33.3%). The rate of
severe thrombocytopenia group was the lowest of antiplatelet antibodies test
positive (28.6%). In the subgroup without anti-platelet antibodies, the rate of
mild→severe thrombocytopenia in each group gradually increases by
64.7%→70.4%→71.4%. The rate of moderate thrombocytopenia was the
highest proportion (47.5%) compared to severe (25.0%) and mild (27.5%). In
the group anti-platelet antibodies test positive, the moderate thrombocytopenia
accounts was highest (44.5%) and the rate of severe thrombocytopenia was the
lowest (22.2%).


11
3.2.24. Relationship between maternal anti-platelet antibodies and disease
progression
* Group with antiplatelet antibodies
Table 3.20. Patient distribution stratified bythe platelet count in diagnosis
and in labor

Diagnosis
Labor
Platelet
P pair test
n
Rate (%)
n
Rate (%)
<50G/l
6
35.3
4
22.2
No exact
test
50-100G/l
5
29.4
8
44.5
>100G/l
6
35.3
6
33.3
Total
17
100.0
18
100,0

0.0003
fisher's exact test p=0,522
Comment: The rate of severe thrombocytopenia group in after delivery was
reduced than that in beforedelivery (35.3%→22.2%). The rate of moderate
thrombocytopenia group in after delivery higher than before delivery 29.4% →
44.5%. The mild thrombocytopenia group was unchanged (before and after
delivery were still 6 pregnant women). There was 1 for 18 women with antiplatelet antibodies in delivery (mentioned in figure 3.4) had a platelet count in
diagnosis was that in labor.
3.3. Treatment:
3.3.1. Drug therapy:
Table 3.23.Distribution of patients according to the method of treatment
during pregnancy
Method of treatment
Number
Rate (%)
No
39
67.2
Yes
Corticoid
10
52.6
17.2
Method of treatment
4
21.1
7.0
Corticoid + method of treatment
5
26.3

8.6
Corticoid + method of treatment + IVIg
0
0.0
0.0
Total
58
100
Comment: More than half of the patients do not need of drug therapy (67.2%).
Among patients who required of treatments, 52.6% were treated with steroids,
21.1% platelet transfusion alone, which was the lowest percentage (21.1%).
3.3.2. Treatment in the labor:


12

Numberof women

Table 3.24.Distribution of patients according to the indicating of Platelet
transfusion during labor
Method of
Yes
No
Total
treatment
n
Rate (%)
n Rate (%)
n
Rate (%)

Number of platelet
56.0
0.0
24.1
<50G/l
14
0
14
100.0
0.0
100.0
36.0
54.5
46.5
50-<100G/l
9
18
27
33.3
66.7
100.0
8.0
45.5
29.3
100-<150G/l
2
15
17
11.8
88.2

100.0
Total
25
100.0
33
100.0
58
100.00
53.7±30.1G/l
98.3±21.5G/l
fisher's exact test
x̅ ± SD ± SD
(14-158G/l)
(68–147G/l)
p=0,000
Comment:For the group of severe thrombocytopenia, platelet transfusion
was during labor (100%). For the group. For the groupof mild
thrombocytopenia, the rate ofhaving neededfor platelet transfusion alonewas
lowest (8.0%). The rates of indicated treatments of 3 levels thrombocytopenia
including beingsevere → moderate → mildwas 100.0% → 33.3% → 11.8%
respectively. Seemingly, the more severe of disease the higher rate of indicated
treatments. Thedifference was insignificant (p <0.05).
3.3.5. Relationship between platelet count at delivery and obstetric
treatments:

Ceasarean
Vaginal delivery
Assited vaginal delivery

Platelet count

Figure 3.10. Distribution ofplatelet count at delivery and obstetric
treatments
Test Fisher p=0.108
Comment: For the group severe thrombocytopenia, theindications for cesarean
delivery was compulsory (100%:15/15). The rate of indications for cesarean
delivery decreased gradually with the degree of thrombocytopenia:
<50G/l→50-80G/l →> 80G/l, respectively 100% (15/15)→81.25% (13/16)
→77.8 % (21/27). However, this difference no was significant (p> 0.05). In the


13
caesarean section group the rate of the group of having platelet ratios > 80G/l
was the highest (accounted for 42.9%). In the vaginal delivery group, the rate
of group of having platelet ratios> 80G/l was the highest (accounted for 62.5%
comparing to 2 other groups with 37.5% and 0%, respectively) and had 1
forceps.
3.4. The hematological indices in febrile newborn
3.4.1. The platelet count of neonatal

Figure 3.11. Patient distribution stratified by the neonatal platelet count
Comment: There was 16 among 58 pregnant women had a newborn with
thrombocytopenia (27.6%). There was 10 for 16 neonatal thrombocytopenia
with platelet count 100-<150G/l (62.5%); 5 for 16 of them with platelet count
50-<100G/l (31.25%) and one of them with platelet count <50G/l (6.25%:
platelet count 20G/l), none neonatal bleeding. The mean neonatal platelet count
̅ ±SD=208.4±79.5G/l (20-393G/l).
was:𝒙
3.4.2. The neonatal anti-platelet antibodies

Figure 3.12. Patient distribution stratified by the neonatal anti-platelet
antibodies
Comment:There was 9 for 58 neonates (15.5%) whose mothers with positive
anti-platelet antibodies test.
3.4.4. Relationship between maternal anti-platelet antibodies and neonatal
thrombocytopenia
Table 3.30. Relationship between anti-platelet antibody of pregnancy
women and the number of platelet in their newborns
Platelet newborn
<150G/l
>150G/l
Total
APA mother
n
%
n
%
n
%
%
Positive
6
33.3
12
66.7
18 100.0 31.0
Negative
10
25.0
30

75.0
40 100.0 67.0
Total
16
27.6
42
72.4
58 100.0 100.0
fisher's exact test p=0.78; OR=0.5


14
Comment: The rate of thrombocytopenia in infants whose mothers got
antibodies around 33.3% was higher than that of infantswhose mothers got no
antibodies (APA) mothers. This difference was insignificant (p <0.05).
3.4.5. Relationship between number of platelet and anti-platelet antibody
in newborns
Table 3.32. Relationship between anti-platelet antibody and number of
platelet in newborn of group negative anti-platelet antibodies mothers
<150G/l
≥150G/l
Total
Platelet newborn
APAof mother
n
%
n
%
n
%

Positive
50.0
50.0
9
50.0
3
6
33.3
66.7
100.0
Negative
50.0
50.0
50.0
3
6
9
33.3
66.7
100.0
Total
6
12
18
fisher's exact test p=1.000
Comment: The anti-platelet antibodies positive in 9 out of 18 newborns of
pregnancy women who had anti-platelet antibodies. The rate of
thrombocytopenia newborn in group of their mothers who had positive antiplatelet antibodies is 50%. The rate of thrombocytopenia newborns in group of
their mothers who had negative anti-platelet antibodies is 50%.
DISCUSSION

4.2. Clinical feature, laboratory
4.2.1.The gestational age at diagnosis
In table 3.2, themean gestational age at diagnosis is 30.2 ± 7.8 weeks on
average, the earliest 8 weeksand the latest 41 weeks. The highest rate of
gestational age at diagnosis was 28 weeks or more. Our results were concurrent
with other authors in Vietnam (therate over 28 weeks: 96.6%) andthe world
(the rate of third trimester pregnancy was 95.6%). According to table 3.12, the
rate of successful detecting increased gradually according togestational
ages(the first, the second, and the thirds trimester were 16.07%, 7.14, 76.79%,
respectively).Itcontradicts to the resultsof the study by Saniya Sharma et al
2017 (35.1%; 46.8%; 18.1%).
This could be explained for the following reasons: Data collected from
2014where was before the“National Guidelines on Reproductive Health
Services” in 2016 began effective so theblood testsforthe first trimesterwere
not routineand only those for the third trimester had been done properly for
themedical records. In our study (table 3.11), thrombocytopenia diagnosed in
the second or third trimesters were among the highest casesduring antenatal
care (55.6% and 68.2%, respectively). Due to the lack ofawareness, many
pregnant women thought that ultrasound was for prenatal examination, so they
do not go to the examination and do basic tests. Only until the laborscame, the
tests detecting the possible diseases gotdone.In this study, 8/58 pregnant
women (13.8%) detected when laboring


15
4.2.2.The gestational age at delivery
In the present study, our results were concurrent with other authors around the
world on mean gestational age at delivery. Table 3.3 shows that the mean
gestational age at birth is 38.9 weeks (the youngest is 34 weeks, the oldest 41
weeks). This result is similar to those results of Fujita et al. (2010) who pointed

out that the mean gestational age at birth is 38 weeks (range 33-41 weeks) as
well as Vesna Elveđi-Gašparović et al. 2016. In our study, there were only
twopremature labor cases (34 weeks and 35 weeks) admitted to the hospital for
labor, and no cases with pregnancy suspension due to medical conditions.
4.2.5.The cause of diagnosis
Figure 3.3 shows that 78.9% of the diseases are accidentally discovered. This
result is completely consistent with the study of Sumathy D. et al. In our study
(table 3.11) shows that the thrombocytopenia in pregnancy was diagnosis by
hemorrhagic symptoms only 6.9% (4 pregnant women). This rate is lower than
that of Care A. et al. 2018 (9/107). However, the research subjects of study by
Care A. et al only are the ITP, so the rate of thrombocytopenia in pregnancy
was diagnosis by hemorrhagic symptoms would be higher (four bruises; two
purpura, threegum bleeding).
According to our research (table 3.11): five pregnant women were diagnosis
thrombocytopenia in the first trimester of pregnancy (8.6%_ according to table
3.2) mainly due to prenatal screening tests. And antenatal care (60%).
Specifically,three detected by testing (among them, two went for prenatal
screening tests; the remaining patient already had the anamnesisof
thrombocytopenia in pregnancy so blood tests compulsory), the other onewho
went for antenatal care at the National Obstetrics and Gynecology hospital
indicated for the prenatal screening testsand blood counts and the last one
bleeding at 8 weeks came for a blood test. According to the prenatal check-up
procedure in the first trimester, women have to go for antenatal care at least
once, so there is a question here: these women mostly develop
thrombocytopenia after the first trimester of pregnancy (100% - 8,6% = 91.4%)
or did the disease appear earlier but missed diagnosis (due to not having blood
count in the first trimester of pregnancy)?
Thrombocytopenia occurs in the second and third trimesterfound by antenatal
cares among the highest proportions (55.6% and 68.2%): one pregnant woman
went to the doctor for bleeding at22th week and another for root bleeding at

31th week. However, in these cases, when thrombocytopenia was diagnosed,
platelets were both in a severe thrombocytopenia (<50G / l). The question we
ask here as well as the one above: did the thrombocytopenia missedin the first
trimester of pregnancy and only detected later?
4.2.6. Bleeding Symptoms
According to our study (table 3.7): out of 58 patients, only 4 patients (6.9%)
with moderate thrombocytopenia had bleeding (bleeding teeth, nosebleeds) ;


16
There were no cases of severe hemorrhage; There was also no case of mild
bleeding (bleeding into the skin). This rate is lower than the study of Nguyen
Trong Tuyen in 2016 (13.9%) in which 65.2% was bleeding into the skin,
34.8% was hemorrhage.
During labor, we did not experience any bleeding, although only two of four
women had to be treated for thrombocytopenia with corticosteroids and platelet
transfusions, and the other two women only monitored platelet counts at the
provincial hospital. Unlike the study of author Nguyen Trong Tuyen (2016), at
the start of labor, 9.6% of pregnant women had bleeding.
Relationship between hemorrhagic symptoms and platelet count: In our study
(table 3.14) showed that: in the group of women with hemorrhagic symptoms,
the rates between two groups of severe thrombocytopenia (<50G/l) and
moderatethrombocytopenia (50-100G/l) are the same (50.0%), but in each
grading of thrombocytopenia, the rate of hemorrhage is found in the severe
thrombocytopeniagroup (9.5%). It is significantly higher than this rate in the
moderate thrombocytopenia group (8.7%).
We did find any case with hemorrhagic symptoms in the group of mild
thrombocytopenia (platelet count> 100G/l: 0%). This result is completely
consistent with the research of other authors in the world.
In our case-by-case analysis, there are two pregnant women with anti-platelet

antibodies into the four women with hemorrhagic symptoms. However, while
studying at the data collection we encountered a severe postpartum
hemorrhage, which we will discuss later in the postpartum follow-up.
4.2.7. The platelet counts
* At diagnosis :
In our study (graph 3.4 and table 3.8) the mean platelet count at detection
was 79.07 ± 33.74G/l (14–158G/l) and there were categories of 3 levels of
platelet counts: mild (21.4%), moderate (41.1%), severe (37.5%). This rate like
results ofother authors in the country in 2014 (platelet counts <50G/l: 24.7% +
14.5% = 39.2%). Compared with foreign authors, Xiaoyue Wang et al. 2017
the mean platelet count at detection was 59.6 ± 23.8G/l (10-98G/l) with levels
of thrombocytopenia: mild thrombocytopenia (89.1%), moderate
thrombocytopenia (7.6%), severethrombocytopenia (3.2%).
* Relationship between gestetional age and platelet count at diagnosis
In our study (table 3.12), the rate of detecting demand deceleration
increases gradually with gestational age (the first trimester: 7.14%; the second
trimester: 16.07%; the thirds trimester: 76.79%). The low platelets in the first
trimester of pregnancy with the highest rate of severe group more than other
two groups: moderate and mild thrombocytopenia (75%; 0%; 25%). This we
will discuss later, in the section on anti-platelet antibodies. However, the low
platelets in the second of pregnancy, the level of thrombocytopenia in other
group were similar (33.33%; 33.33%; 33.33%). However, because the sample


17
size is not large enough, this is not enough to reach a conclusion (p> 0.05).
In contrast to the results of Saniya Sharma et al. 2017 in the first of pregnancy
there were no cases of severe thrombocytopenia (0.0%), only moderate
thrombocytopenia (9.1%) and mildthrombocytopenia (90.9%) .Of which was
mostly mild thrombocytopenia (second of pregnancy: mild thrombocytopenia:

68.2%), only severe thrombocytopenia was reported in the third
trimesterof pregnancy (11.8%) but decreased in the thirdtrimester
of pregnancy. Mean platelets make up the majority (47.1%). The morbidity
pattern of this study differs from our own because the thrombocytopenia in
pregnancy was diagnosis earlier than us (Q1: 35.1%; Q2: 46.8%; quarter 3:
18.1%).
* At labor:
In the study of Saniya Sharma et al, there were 67/94 (35.1%) cases of mild
thrombocytopenia, 44/94 (46.8%) was moderate thrombocytopenia, only 17/94
(18.1%) cases of severe thrombocytopenia.
Unlike the study of Xiaoyue Wang et al (2017), all cases of thrombocytopenia
in pregnancy (without anti-platelet antibodies) is mild because of the study we
have up to 82.25% of the case could be due toITP (figure 3.5).
In our study (table 3.2), the rate of detecting pregnancy thrombocytopenia in
the first, second, third trimester respectively: 8.6%; 15.5%; 75.9%, if according
to the hypotheses of the above authors, the rate of GT will be high and the rate
of ITP will be low. However, in fact, our research results (table 3.2) were not
the case: the number of platelets count detection on averagewere 79.07 ±
33.74G/l (14-158G/l) with levels thrombocytopenia: mild (21.4%), moderate
(41.1%), severe (37.5%). Platelet count at birth 65.7 ± 33.4 G/l (1-125G/l) with
levels of thrombocytopenia: mild (22.1%), moderate (46.6%), severe (29.3%).
This difference can be explained by two reasons. First, while ITP pregnancy
could begin early in the first trimester pregnancy, it might occur at any time
during pregnancy. In a study published in the New England Journal of
Medicine, the researchers evaluated platelet counts in pregnant women at birth
and found that platelet levels decreased gradually and continuously by about
17% in uncomplicated pregnant women. Second, women went to a doctor's
office too late (just found out when registering for a pregnant record: 62%)
even they took test to detect thrombocytopenia just prior to labor (14%).
Although James N. George (1996) et al. recommend that during the first

trimester pregnancy (the mean gestational age: 8.7 weeks), the platelet counts
of pregnant women was significantly lower thannon-pregnant women so the
disease couldgo silent for a long time without being detected by GT and ITP,
completely asymptomatic. Therefore, it could explain that we detected
pregnancy thrombocytopenia too late because the antenatal care had not been
done in a timely manner.


18
* Atfter labor:
According to Berit L. Dahlstrom et al. (1994) whose study on 22 pregnant
mothers with thrombocytopenia, there was no change in platelet count after
vaginal delivery. For the cases withcaesarean section, the platelet count
decreased by 2.5% on averageon the first postoperative day and increase of 5%
on third postoperative day on average.
For this study, we did not consider platelet counts during the postpartum period
for the following reasons: there were 8 patients who not re-tested for
postpartum blood counts after cesarean sections and 25/58 women who
hadplatelet transfusion at the time of labor. We also found thatthe more severe
of the disease the higher rate of platelet transfusionincreases with the level of
thrombocytopenia (Table 3.3). Therefore, the platelet counts during the
postpartum period did not give many values for this study
4.2.9. Maternal antiplatelet antibodies
The rate of thrombocytopenia with the cause of ITP accounts for 53.4%
(31/58- Figure 12). However, may be there was the ITP patient with platelet
counts >80G/l, so if considering the consequences of thrombocytopenia in the
newborn or not affecting the newborn, but there is anti-platelet antibodies in
the serum, this rate our research is even higher: 83% (Figure 3.6). Although
platelet counts below 70G/l are more common in ITP, they are not uncommon
in GT, so this ratio is only for reference.

Our study showed that: rate of maternal anti-platelet antibodies is the highest in
the mild thrombocytopenia group (35.3%) that islowest in the group
severethrombocytopenia (28.6%) (table 3.23). This is in line with the
recommendation "When GT is suspected but platelet count falls between 5080G/l a diagnosis of immune thrombocytopenic purpura could not be excluded.
Platelet values below 50G/l in a pregnant woman exclude GT and require the
search of another etiology.”by Anca Marina Ciobanu (2016).
→So there arise the problem in here that: should blood tests as well as
specialist testsbedone in early pregnancy to find out low platelets.
In terms of disease progression, after delivery, the rate of severe
thrombocytopenia in the maternal group with anti-platelet antibodiesprior labor
fall from below 35.3% to 22.2% after labor (table 3.24). Same token,the rate of
severe maternal group without anti-platelet antibodies 38.5% → 25.0% (table
3.25). This is because the pregnant women got treated with platelet
transfusions during pregnancy (3 women with anti-platelet antibodies and 6
women without). This issue we will analyze further in the section on medical
treatment indications. However, for pregnant women with anti-platelet
antibodies, despite being treated, some cases had the platelet count decreased
more than 126G/l to 27G/l.
Based correlative analysis between anti-platelet antibodies with
hemorrhagic symptom and platelet count, we found thatthe anti-platelet


19
antibody could not be useful in disease prognosis but it wassuggetive for close
monitoring of the patient's condition.
4.3. Treatment by Attitudes
4.3.1. Treatment during pregnancy
In our study (table 3.33), 67.2% of patients had no treatment during pregnancy.
In which, treatment: 17.2% corticoids, 7% platelet transfusion, 8.6% corticoids
and platelet transfusion combined and none intravenous immunoglobulin

(IVIg).
Our results are in agreement with previous studies of Kieu Thi Thanh (2008)
and Nguyen Trong Tuyen (2017), the group of platelet transfusions alone
(4,4% and 5.4%); group of platelet transfusion and corticoid combined had the
highest rate (42.9% and 22.3%). However, unlike the study results of Kieu Thi
Thanh, as well as the results of Nguyen Trong Tuyen, there is no case to IVIg
treatment.
In terms of ratios of platelet transfusion, our study results also in line with
those of Vijay Zutshi et al (2019) who had alsostudied over 200 women,
among them 13 cases (6.5%) of platelet transfusion.
→The problem posed here is repeated from the above analysis: Pregnant
women need to had prenatal check-ups and early tests to timely detect the
disease as well as examine and treat specialist.
4.3.2. Management parturition
4.5.2.1. Platelet transfusion
According to our study (table 3.34), the rate of platelet transfusion during labor
was 25/58 women (43.1%). It is indicated absolutely in the subgroup of severe
thrombocytopenia during labor (100%). The ratio of platelet transfusion alone
in the mild thrombocytopenia group was lowest (11.8%). The indicated ratio of
thrombocytopenia decreasedaccordingly to the degree of thrombocytopenia.
Those in severe→moderate→mildis 100%→33.3%→ 11.8% respectively. The
mean values of the platelet transfusion subgroup 𝑥̅ ± SD = 53.7 ± 30.1G/l (14158G/l) and the subgroup without platelet transfusion 𝑥̅ ± SD = 98.3 ± 21.5G/l
(68-147G/l). This difference was statistically significant (p <0.05).
Similar to our conclusion, the results of Nguyen Trong Tuyen (2016) had
confirmed "the rate of platelet transfusion increases with the degree of
thrombocytopenia". In line this author on the mean values of group with
platelet transfusion ( 𝑥 ± SD = 49.5 ± 24G/l; 4-100G/l) but that of group
without platelet transfusion (𝑥 ± SD = 82.62 ± 13, 1G/l; 42-100G/l) was lower
than ours. However, the rate of platelet transfusion during labor (63.9%) and
the rate of pregnant women with platelet count> 100G/l (27.7%) was higher

than ours (8.0%)→Is the indication for platelet transfusion during labor for
thrombocytopenic women increasingly stricter?
Platelet transfusion completely complies in the group of pregnant women with
platelet count below 50G/l that was indicated with the above recommendation.


20
However, in the group with a platelet count of 50-100G/l the indication for
platelet transfusion in our study was too broad (11/27 women-including 3
women with anti-platelet antibodies).Especially, which was 1 pregnant woman
with platelet count> 100G/l even though all of these women had no symptoms
of bleeding.
→So the problem here was to reconsider the indication for platelet transfusion.
4.3.2.2. The indicated cesarean section
The caesarean section rate in our study was higher than Kieu Thi Thanh (2008)
and Nguyen Trong Tuyen (2016) (128/166-77.1%). Our study was different
than Kieu Thi Thanh but agree with Nguyen Trong Tuyen: the vaginal delivery
rate in group of platelet count >80G/l was highest (60.9%) and one case of
forceps delivery and the caesarean section rate in the group of platelet count
<50G/l was also highest (90.2%). However, unlike Nguyen Trong Tuyen’s
study, the ratios of those whose platelet count >80G/l and got vaginal delivery
or caesareans were highest(62.5% or 42.9%, respectively)
This was explained by the difference in terms of the distribution of pregnant
women according to the number of platelets: the subgroup of platelet count >
80G/l in Nguyen Trong Tuyen's study accounted for 27.7% while ours 46.5%
(27/58-Figure 3.12).
The vaginal delivery ratio in our study was 13.8% andit was lower than that of
the studies by the other authors in the world, for example 60% pregnant women
with ITP and87%from Fujita et al (2010). On the contrary, the caesarean
section ratios in our study and studies done by the domestic authors was higher

than theseof foreign authors’ (usually fluctuatedwithin the range of 40%).
According to WHO, when the platelet count > 80G/l, all of indicated cesarean
section was obstetric indicated.
→Going back to our research results, we found that the indicated cesarean
sectiondue to the large drop in platelet count compared was a wide range of
indication thanthe research results and the recommendation for that in the
world. So it was necessary to reconsider so that theindicated cesarean section
was made more closely.
4.3.2.3.Pain relief for cesarean section
Up to now, there are no study guidelines which suggest specifically in terms of
platelet count for the lower limit deemed safe for epidural or spinal anesthesia.
There was no data for supporting minimum platelet count specifically to
regional anesthesia and as result, each case must be considered individually.
Other studies only provide limited data and retrospective to solve this problem.
Most experts consider a platelet count in the range of 80G/l is adequate for
epidural or spinal anesthesia if the patient were without any acquired or other
congenital coagulation disorder, his/her platelet level was stable and platelet
function was normaland was not receiving any anti-platelet or anticoagulant
therapy.


21
This was also acceptable with the lower platelet count but there was not enough
published evidence to make a recommendation for this time. For patients with the
platelet count less than 75G/l, an individual decision should be made based on risks
and benefit analysis. However, the other authors also recommended general
anaesthesia to the mothers whose platelet count was 20-30G/l.
Absolute contraindication for epidural anesthesia for the cases of low platelet
count and severe coagulation disorder. However, the risks and benefits of
epidural anesthesia should be evaluated individually on the patients who with

low platelet countsand have no clinical sign of coagulation disorder.
According to the British Society for Haematology’s Guidelines that the platelet
count should be at least 80G/l to need to achieve a safe epidural anesthesia on
pregnant women with ITP. However, most of the anesthesiologists and authors
report that they had used nerve blockade techniques, especially spinal anesthesia in
healthy pregnant women with ITP with platelet count above 50G/l.
→This problem was: should be indicated epidural anesthesia more closely than
those another recommendations in the world.
4.4. Neonatal conditions
4.4.1. Platelet
* Platelet count in newborns:
According to our study, the mean platelet count in infants was 208.4 ± 79.5G/l
(20–393G/l) (Figure 3.7). Among 58 infants, there were 16 infants with
thrombocytopenia (29.6%: table 3.30) including: 10 infants with platelet
countsat 100–150G/l (62.5%); 5infants with platelet counts at 50–100G/l
(31.25%) and one of them with platelet counts <50G/l (6.25%:20G/l), no
newborn bleeding.
At Present, we have not found any domestic research for comparison.
The results of our study are lower than that of Anteby E. and Shalev O.
when they identified 22 women with thrombocytopenia of <100G/l, 4
pregnant women with second pregnancy, these authors found: Neonatal
platelet counts were normal (270,7±69,9G/l), and none of the newborns
(n=24) had a bleeding diathesis.
→In comparison, we found that: the rate of neonatal thrombocytopenia of
pregnant thrombocytopenic women was very different in several studies,
difficult to predict. To find prognostic factors, we consider the following
associations:
* Relationship between maternal and infants platelet levels:
However, when considering the relationship between the platelet count of the
pregnant woman and the infant Aiyelaagbe S. et al. (2014) who had been

studying over 215 women with a platelet count ≤120G/l during pregnancy and
maternal platelet count did not correlate with either blood loss or neonatal
platelet count.


22
In our study (table 3.28), the rate of thrombocytopenia in neonates that was
highestin the maternal with severe thrombocytopenia (42.9%) and lowest of
maternal with moderate thrombocytopenia (22.2%) however, this difference no
was significant.
This result was consistent with the studies of Vijay Zutshi et al. (2019) they
recruited a total antenatal women screened were 1560 during this 6-month
period, out of which 200 pregnant women were GT. When conducting research
on these subjects over a period of 6 months, this author to the conclusion that
“neonates were having thrombocytopenia (platelet count < 150G/l) regardless
of degree of maternal thrombocytopenia”.
From all of the above comparisons with our findings, we conclude: no
correlation between newborn platelet counts and maternal platelet counts.
However, in agreement with other authors around the world, we found that
maternal platelet count <50G/l at any point during gestation.
4.4.2. Anti-platelet antibodies of newborn
This problem was once again clarified in Table 3.29. The table anti-platelet
antibodies shows that: there was no difference in the rate of thrombocytopenia
between the group of infants with it and infants without anti-platelet antibodies.
There were only 3 of 6 infants with thrombocytopenia (50.0%) had anti-platelet
antibodies and 6 of 12 infants without thrombocytopenia (50.0%). had antiplatelet antibodies. Which was significantly higher than studying of Svetlana G
Khaspekova et al. (2019) (3.2%), but almost the same. with that of V.
Gandemer et al. in 1999 (11/21 women) pointed out. When studying 21
pregnant women with isolated thrombocytopenia plus specific platelet
autoantibodies detected during pregnancy, the author found that 3/21

thrombocytopenic infants (with anti-platelet antibodies), that was lower than
our study (33, 3%) and 18/21 neonates without thrombocytopenia (8/18 cases
with anti-platelet antibodies –that was lower than our results: 50.0%).
4.4.3. Anamnesis
According to our study (table 3.31) there were three cases with anamnesis and
two cases of neonatal thrombocytopenia (one with anti-platelet antibodies and
another without). The ratio of thrombocytopenia in the subgroup of neonates
whose mothers with anamnesis (66.7%) was higher than that of these whose
mothers without (25.5%). Although the difference in our study was not large
enough for statistical significance (p> 0.05) but it completely agreed with the
results of other authors in the world.
4.4.4. Bleeding
In our study (table 3.32) there were 17 thrombocytopenic infants, none of them
had hemorrhage even though there were 5 neonates (31.25%) having a platelet
count <100G/l (3 neonates of mothers infants of with anti-platelet antibodies)
and 1 neonate (6.25%) had platelet count 20G/l (figure 3.7). In our study,
prevalence of neonates having a platelet count <50G/l (6.25%) was lower than