Prevalence of and factors associated with severe thrombocytopenia among women with pre-eclampsia seeking obstetric care in Kawempe National Referral Hospital, Uganda

Abstract

Introduction: Severe thrombocytopenia, defined by a platelet count below 100,000/mm³, is asignificant haematological complication observed among women with pre-eclampsia. Preeclampsia, a disorder characterized by hypertension and proteinuria after 20 weeks of gestation, poses substantial risks to maternal and foetal health. Severe thrombocytopenia in pre-eclampsia complicates management and increases the risk of adverse outcomes such as maternal haemorrhage, particularly during delivery, and neonatal complications including preterm birth and low birth weight. Despite its clinical importance, there is limited data on the prevalence and associated factors of severe thrombocytopenia in pre-eclampsia, especially in low- and middle-income countries like Uganda. Understanding these aspects is crucial for improving maternal and foetal health outcomes in affected populations. Methods: This cross-sectional study was conducted at Kawempe National Referral Hospital, Uganda, involving 430 consecutively selected pregnant women diagnosed with preeclampsia. Data on maternal, foetal, and environmental factors were gathered through medical records, patient interviews, and laboratory tests. Statistical analyses, including descriptive, bivariate, and multivariable logistic regression methods (P<0.05), were employed to assess the prevalence and factors associated with severe thrombocytopenia. Results: The study found that the prevalence of severe thrombocytopenia among pregnant mothers with preeclampsia was 9.3%. Factors significantly associated with severe thrombocytopenia included eclampsia (AOR=12.21, CI=1.11-17.54, P=0.04), history of intrauterine foetal death (AOR=3.74, CI=1.01-13.95, P=0.04), and previous use of Labetalol tablets (AOR=3.52, CI=1.21-10.23, P=0.02). Conclusion: The high prevalence of severe thrombocytopenia among preeclamptic women emphasizes the need for enhanced clinical protocols. Routine platelet count assessments should be emphasized in antenatal care services for pregnant mothers with preeclampsia. Capacity-building programs for healthcare workers on thrombocytopenia detection, risk assessment, and appropriate interventions are recommended. Additionally, maintaining comprehensive obstetric records and ensuring the availability of haematological diagnostic equipment are crucial for improving maternal health outcomes. Recommendations: We recommend for a setup of a hospital based clinical guideline with structured follow-up mechanism for pre-eclamptic mothers with a history of IUFD, there should be a clinical guideline protocol that ensures critical care for pre-eclamptic mothers with a history of having used labetalol in management of their blood pressure and more studies on relationship between labetalol use and severe thrombocytopenia among mothers with pre-eclampsia is required.