Incidence and Aetiology of Thrombocytopenia in Twin Pregnancies in a Tertiary Referral Centre
Bibliographic record
Abstract
Abstract Introduction Thrombocytopenia is well described in pregnancy with an incidence of 6-10%. The majority of data with regards to platelet counts in pregnancy and aetiology of pregnancy related thrombocytopenia, however, derives from studies conducted in singletons. There is little information available on this subject in higher order pregnancies. Aim This longitudinal study aims to identify the incidence and aetiology of thrombocytopenia in twin pregnancies in order to guide investigation and management. As a reference we also investigate changes in platelet counts in a cohort of uncomplicated twin pregnancies from our population. Methods Full blood counts (FBC) and pregnancy outcome data were obtained retrospectively from electronic patient records for 676 twin pregnancies over a five year period at our institution. All women required three FBCs to be performed during their pregnancy (booking, second trimester and delivery) to be included in the study. Women with pre-existing medical co-morbidities or medication know to be associated with thrombocytopenia were excluded. A total of 381/676 women were included in the final analysis. From that original cohort, those women with uncomplicated pregnancies who delivered at term (36/40 onwards) were selected to investigate and report a reference interval for platelet count during pregnancy and compare with known reference intervals in singletons. A total of 301/676 women were included in this sub-analysis. Results The mean maternal age was 32.3 years with a mean gestational age of 36.7 weeks at delivery. We defined thrombocytopenia as mild: platelets 100-150 x 109/L, moderate: platelets 50-100 x 109/L and severe: platelets < 50 x 109/L. The table below summarises our results TableFull Blood countMild thrombocytopenia n (%)Moderate thrombocytopenia n (%)Severe thrombocytopenia n (%)1st FBC n=2566 (2.3%)002nd FBC n=38126 (6.8%)1 (0.3%)03rd FBC n=38177 (20.2%)12 (3.2%)1 (0.3%) The overall rate of thrombocytopenia was 23%. The commonest cause of thrombocytopenia in this population was gestational thrombocytopenia (75%), followed by pre-eclampsia (15%) other hypertensive disorders (5.7%) and the remaining 4.3% included other complications such as sepsis and obstetric cholestasis. The platelet ranges for our cohort of women with uncomplicated pregnancies were as shown in the table below. These results are in keeping with changes which occur in platelet counts in singleton pregnancies. TableFull Blood countMean plt count (109/L)Range95% interval1st FBC247135-390163-3262nd FBC226115-410147-3443rd FBC18526-427110-317 Conclusion This study demonstrates that while the incidence of thrombocytopenia is double the rate in twin when compared to singleton pregnancies, the overall distribution in terms of aetiology is very similar. Interestingly this differs somewhat from data in triplet pregnancies where the majority of thrombocytopenia appears to be secondary to pre-eclampsia in one case series. This is an important finding as it indicates that like in most singleton pregnancies the majority of cases are benign and as such investigation and management pathways regarding thrombocytopenia should not differ from investigation and management in singleton pregnancies. However the increased incidence of thrombocytopenia in twin pregnancies overall requires further investigation. Disclosures No relevant conflicts of interest to declare.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".