Safe Epidural Analgesia in Thirty Parturients with Platelet Counts Between 69,000 and 98,000 mm-3

Anaesthetic management of a parturient with Laron syndrome

“…Fortunately there were no neurological sequelae postoperatively. Whilst neuraxial block has been reported in patients with thrombocytopenia, [20][21][22][23] we are not recommending this technique at such low platelet counts. If we had known the platelet count was <50 · 10 9 /L we would have transfused platelets to cover the CS and a decision regarding neuraxial anaesthesia would have been made after a risk-benefit discussion with the patient This case report highlights the problems associated with LS, successful use of neuraxial anaesthesia and the need for effective communication between the anaesthetist, haematologist and obstetrician while dealing with a complex patient.…”

Thrombocytopenia and Low Molecular Weight Heparin in the Parturient

“…1 An epidural or spinal hematoma can be a catastrophic complication and can lead to permanent paralysis. This decrease is usually not clinically significant nor does it generally impact on the decision to place an epidural anesthetic.…”

“…This decrease is usually not clinically significant nor does it generally impact on the decision to place an epidural anesthetic. 2 Recently, their recommendation has been challenged, primarily because thrombocytopenia occurs frequently during pregnancy 1 and neuraxial anesthesia is safer than general anesthesia for the parturient. 1 An epidural or spinal hematoma can be a catastrophic complication and can lead to permanent paralysis.…”

“…A laminectomy was performed six hours after epidural catheter placement at which time 4 mL of blood were drained. 1,25,26 In the largest study, Beilin et al 1 reviewed the medical records of 15,919 consecutive parturients during a three-year period. Whether the 4 mL of epidural blood was sufficient to cause her symptoms is unknown; it is possible that the symptoms were related to residual local anesthetic effects.…”

Immune Thrombocytopenia in Pregnancy

“…The American Society of Hematology guidelines (Table 3), suggest that a maternal platelet count of 50,000/μl is sufficient for vaginal delivery as well as cesarean section. The BCSH guidelines recommend that a platelet count of 80,000/μl be attained for cesarean delivery as well as for epidural anesthesia, based on a retrospective review in which epidural anesthesia was successfully delivered with no neurologic complications in 30 thrombocytopenic women with platelet counts between 69,000-98,000/μl [59]. Thus, though no prospective, randomized data is available to address this issue definitively, most experts consider a platelet count in the range of 80,000/μl adequate for epidural anesthesia and either vaginal delivery or cesarean section in the parturient.…”