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The effect of betamethasone treatment on platelet count and thromboelastography (TEG®) coagulation profile in obstetric patients
Abstract Number: 27
Abstract Type: Original Research
Antenatal corticosteroid administration decreases neonatal morbidity and mortality by reducing the risk of respiratory distress syndrome and neonatal death (1). Corticosteroid therapy for fetal lung maturation quantitatively increases maternal platelet count (2), but the qualitative effect on maternal global coagulation has never been reported. Thromboelastography® (TEG®) is a blood coagulation assay useful for detection and treatment of hypercoagulable states and coagulopathies in obstetric patients (3,4,5). The aim of this study was to evaluate the platelet count and TEG of parturients before and after receipt of betamethasone given for fetal lung maturation in preterm labor . Our hypothesis was that betamethasone treatment may qualitatively affect maternal coagulation profile.
After IRB approval, pregnant women between 24-34 weeks’ gestation scheduled to receive betamethasone treatment were recruited. Patients with known genetic thrombophilia or current or recent use of medications that effect coagulation were excluded. Eligibility for betamethasone therapy was determined by the obstetric care provider. Patients received two 12 mg doses of IM betamethasone, 24 hours apart. Blood was collected prior to administration and 8 hours after each of the two doses. Samples were analyzed for platelet count and TEG variables of reaction time (r), clot formation time (k), and maximal amplitude (MA). Data were analyzed with paired t-test.
10 parturients were enrolled in the study, and 7 completed the study. Platelet count before and after betamethasone treatment was unchanged (MD 6; 95% CI to 13-25; p = 0.47). When comparing values pre and eight hours post-2nd betamethasone, r time decreased from 4.34 mm to 3 mm (MD=0.34; 95% CI -0.11 to 0.795; p=0.113), k decreased from 1.3 mm to 1.2 mm (MD 0.1; 95% CI -0.482 to 0.682; p=0.689) and MA increased from 68.9 mm to 69 mm (MD 0.1; 95% CI -3.4 to 3.12; p=0.91). A positive relationship is shown by a scatter plot of MA and platelet count.
Our preliminary TEG results indicate a trend toward enhanced coagulation in parturients after betamethasone treatment for fetal lung maturation. The decrease in r time, although modest, may reflect a relative hypercoagulable period after steroid therapy that does not correlate with increased platelet count. There was a positive correlation between MA and platelet count. The effect of corticosteroids on increasing platelet count is inverse to the degree of initial thrombocytopenia (2). The modest effects of corticosteroid treatment on coagulation shown in this preliminary study may be more pronounced in the population with underlying thrombocytopenia. TEG may be a sensitive global coagulation assay to monitor hematologic response to corticosteroid treatment in such patients.
1. Obst Gyn 2007;110:26-31
2. Arch Gyn Obst 2006; 274:130-2
3. A&A 1997;85:94-8
4. IJOA 1994;3:229-33
5. A&A 2002;95:1063-6