Highlights
- •Women with low platelet counts may be excluded from a neuraxial block for delivery.
- •General anesthesia rates are higher among women with low platelet counts.
- •Data on 308 neuraxial blocks among women with a platelet count <100 000/μL.
- •There were no cases of spinal epidural hematoma.
- •The risk of a neuraxial hematoma when platelet count is <70 000/μL remains unknown.
Abstract
Background
Laboring women with low platelet counts may be denied neuraxial block due to concerns
about causing a spinal-epidural hematoma.
Aims
To assess the anesthetic management, complications and outcome variables of women
with low platelet counts, and to expand the existing data regarding the safety of
neuraxial blocks in this patient population.
Methods
This is a retrospective analysis of anesthetic and obstetric data from women with
platelet counts <100 000/μL, who were admitted to a single referral center during
2011–2014. The rate of neuraxial block and related complications were examined in
relation to the platelet count and the results combined with published data to assess
the risk of spinal-epidural hematoma.
Results
During the study period, 471 of 45 462 women (1%) had a low platelet count (<100 000/μL).
The rate of neuraxial block was significantly higher in women with platelet counts
of 70–99 000/μL (280/394, 71.1%) when compared to women with platelet counts of 50–69 000/μL
and 0 to 49 000/μL (23/59, 38.9% and 5/18, 27.8%, respectively, P <0.0001).
Women in the lower platelet count ranges had a higher risk of cesarean delivery under
general anesthesia and longer hospital stay. No neuraxial hematoma were reported.
Conclusions
This study contributes a substantial series of neuraxial blocks among women with low
platelet counts. The findings support that the risk of hematoma is low if the platelet
count is <100 000/μL, specifically between 70 and 99 000/μL. Risk assessment in the
lower count ranges requires a much larger sample.
Keywords
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References
- Thrombocytopenia in pregnancy.Blood. 2017; 130: 2271-2277
- Immune thrombocytopenic purpura in pregnancy.Curr Opin Hematol. 2007; 14: 574-580
- Thrombocytopenia in the parturient.Anaesthesia. 2004; 59: 255-264
- Moderate to severe thrombocytopenia during pregnancy.Eur J Obstet Gynecol Reprod Biol. 2006; 128: 163-168
- Nationwide incidence of serious complications of epidural analgesia in the United States.Acta Anaesthesiol Scand. 2016; 60: 810-820
- Epidural anesthesia in pregnant patients with low platelet counts.Obstet Gynecol. 1988; 71: 918-920
- Neuraxial anesthesia in parturients with thrombocytopenia: a multisite retrospective cohort study.Anesth Analg. 2015; 121: 988-991
- Neuraxial anesthesia in parturients with low platelet counts.Anesth Analg. 2016; 123: 165-167
- Risk of epidural hematoma after neuraxial techniques in thrombocytopenic parturients.Anesthesiology. 2017; 126: 1053-1063
- Maternal thrombocytopenia in pregnancy. Diagnosis and management.Clin Lab Med. 2013; 33: 327-341
- Diagnosis and management of maternal thrombocytopenia in pregnancy.Br J Haematol. 2012; 158: 3-15
- If nothing goes wrong, is everything alright?.JAMA. 1983; 249: 1743-1745
- The ongoing challenges of regional and general anaesthesia in obstetrics.Best Pract Res Clin Obstet Gynaecol. 2010; 24: 303-312
- Anesthesia-related maternal mortality in the United States: 1979–2002.Obstet Gynecol. 2011; 117: 69-74
- Regional anesthesia and non-preeclamptic thrombocytopenia: Time to re-think the safe platelet count.Rev Bras Anestesiol. 2009; 59: 142-153
- Safe epidural analgesia in thirty parturients with platelet counts between 69,000 and 98,000 mm3.Anesth Analg. 1997; 85: 385-388
- Regional anesthesia in parturients with low platelet counts.Can J Anesth. 2005; 52: 114
- Unrecognized thrombocytopenia and regional anesthesia in parturients: a retrospective review.Obstet Gynecol. 1989; 73: 943-946
- Epidural anaesthesia and thrombocytopenia.Obstet Anesth Dig. 1990; 10: 7
- Thrombelastography changes in pre-eclampsia and eclampsia.Br J Anaesth. 1996; 77: 157-161
- Utility of thromboelastography during neuraxial blockade in the parturient with thrombocytopenia.AANA J. 2014; 82: 127-130
- Practice Guidelines for Obstetric Anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology.Anesthesiology. 2016; 124: 270-300
Article info
Publication history
Published online: February 04, 2018
Accepted:
January 17,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
