To assess the causes and clinical outcomes of maternal near-misses and mortality associated with hematologic diseases.

We retrospectively reviewed the medical records from women who experienced maternal near-misses or mortality attributed to hematological diseases during pregnancy or within 42 days of pregnancy termination, following the World Health Organization criteria, at a single quaternary referral center in Southern Thailand, from 2006 to 2021.

A total of 109 cases were analyzed, including five maternal deaths and 104 near-miss cases related to hematologic diseases. The median (min–max) maternal age was 29 (14–43) years, with 57.8% of the women being multiparous. The most common hematologic diseases were immune thrombocytopenia (68.8%), acute leukemia (6.4%), and aplastic anemia (6.4%). Of these, 48.6% were diagnosed before pregnancy and 57.8% exhibited a platelet count < 50 × 109/L during the intrapartum period. Acute leukemia was the leading cause of death (3/5). Severe maternal outcomes in cases of immune thrombocytopenia were more frequently observed in women with platelet counts < 50 × 109/L.

The primary hematologic diseases causing maternal near-miss and mortality were immune thrombocytopenia, acute leukemia, and aplastic anemia. Acute leukemia was the leading cause of death.