Platelet indices as predictors of hemoglobin decline following cesarean section: A retrospective cohort analysis

Abstract

Objective

To assess the association between preoperative platelet indices and hemoglobin (HGB) decline following cesarean section.

Methods

A retrospective cohort study was conducted on 156 term singleton pregnancies undergoing cesarean delivery. Preoperative platelet count (PLT), plateletcrit (PCT), mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (PLCR) were recorded. The primary outcomes were declines in HGB of≥1 g/dL and≥2 g/dL at 6 hours postoperatively.

Results

No significant differences in platelet indices were found between patients with HGB drop≥1 g/dL versus<1 g/dL. However, PLT and PCT were significantly lower in patients with≥2 g/dL HGB drop (p=0.016 and p=0.003, respectively). ROC analysis identified PLT<234.5×10³/µL (AUC=0.661) and PCT<0.24% (AUC=0.694) as predictive thresholds.

Conclusion

Lower preoperative PLT and PCT levels are associated with a greater decline in HGB after cesarean section. Platelet indices can be considered simple and cost-effective markers for identifying patients at higher risk of significant hemoglobin decrease, once validated in studies with larger patient cohorts.

Keywords

platelet indices - cesarean section - hemoglobin drop - postpartum anemia - thrombocytopenia

Publication History

Received: 25 June 2025

Accepted after revision: 04 December 2025

Article published online:
09 January 2026

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