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Int J Obstet Anesth · Aug 2018
Neuraxial block for delivery among women with low platelet counts: a retrospective analysis.
- N Levy, O Goren, A Cattan, C F Weiniger, and I Matot.
- Division of Anesthesiology, Intensive Care and Pain Medicine, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: levyndv@gmail.com.
- Int J Obstet Anesth. 2018 Aug 1; 35: 4-9.
BackgroundLaboring women with low platelet counts may be denied neuraxial block due to concerns about causing a spinal-epidural hematoma.AimsTo 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.MethodsThis 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.ResultsDuring 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.ConclusionsThis 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.Copyright © 2018 Elsevier Ltd. All rights reserved.
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