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Regional anesthesia for pain at delivery in the presence of maternal thrombocytopenia is a clinical dilemma. We reviewed 10,369 obstetric cases (12 months) from our tertiery center. Generally, hemodilution of pregnancy does not result in thrombocyte counts of &lt;150,000/mm 3  at delivery. A total of 166 births (1.6%) were recorded in women with thrombocytes &lt;150,000/mm 3  at delivery. Parturients with &gt;150,000/mm 3  at week 36 were separated  post hoc  (n=35; 21%) and the remaining parturients were divided as having &lt;100,000/mm 3  (n=30; 18%) or 101,000–150,000/mm 3  (n=101; 60.5%). Epidural or spinal anesthesia was administered to 30% women with &lt;100,000/mm 3  whereas 56% women with &gt;101,000/mm 3  received these options (P=0.003). A total of 13.9% of parturients with trimester-long thrombocytopenia required blood products; 10/23 (43.5%) parturients undergoing cesarean section also required blood products (P=0.000). Four of six babies with Apgar scores of ≤7 at 1-min were born to women with platelets &lt;100,000/mm 3  (P=0.009). There were no statistically significant differences in mean birth weights. Women with thrombocytes &lt;150,000/mm 3  at birth but within the normal range at week 36 were more likely multiparas (P=0.001). We conclude that a difference in maternal and neonatal outcomes exists between mothers who were thrombocytopenic only at delivery compared to those with trimester-long thrombocytopenia, with the latter mothers and babies having more adverse events.

Retrospective audit of outcome of regional anesthesia for delivery in women with thrombocytopenia