Can prepartum platelet indices be a parameter to predict postpartum hemorrhage?

ABSTRACT

OBJECTIVE: Postpartum hemorrhage (PPH) is the single largest contributor to maternal mortality worldwide. It has been demonstrated that certain platelet parameters are indicative of platelet reactivity. The aim of this study was to determine whether antenatal platelet indices can be used as risk factors in the prediction of primary PPH. METHODS: This comparative case-control study involved 3207 pregnant women at term who were recruited over one year period in Istanbul. Postpartum hemorrhage, defined as blood loss ≥1000 mL within 24 h after delivery. The study group consisted of 42 patients who developed primary PPH after vaginal delivery without defined risk factors. The patients in the control group were matched with age, parity, body mass index (BMI), and hemoglobin value. Platelet indices - platelet count, mean platelet volume (MPV), platelet distribution width, and plateletcrit were measured prior to delivery and evaluated for the prediction of PPH. RESULTS: Prepartum MPV and PDW values were determined to be lower in the patients with in the PPH group, when compared to the healthy group (respectively, p < .001 and p < .004). By receiver-operating characteristic analysis, MPV and PDW were able to distinguish between patients with and without any bleeding (respectively, AUC 0.823, 95% confidence interval (CI) 0.735-0.912, (AUC) 0.682, 95% CI 0.569-0.795). Prepartum MPV (cutoff = 10.95 fL) had a high AUC (>0.8) for predicting PPH, with a specificity of 81% and sensitivity of 69%. CONCLUSION: Results suggest a novel hypothesis that pre-delivery lower MPV value may be used predicting PPH.