Anesth Analg 2021 Feb 4. Epub 2021 Feb 4.
From the *Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan †Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota ‡Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York §Department of Medicine, University of Washington School of Medicine, Seattle, Washington ‖Department of Medicine, Medical College of Wisconsin and Versiti, Milwaukee, Wisconsin ¶Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina #Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee **Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Health, New York, New York ††Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, Liaison for the American College of Obstetricians and Gynecologists ‡‡Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts §§Taubman Health Sciences Library, University of Michigan Medical School, Ann Arbor, Michigan ‖‖Department of Medicine, University of Florida, Gainesville, Florida ¶¶Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina ##Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York *#x002A;*Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York.
Because up to 12% of obstetric patients meet criteria for the diagnosis of thrombocytopenia in pregnancy, it is not infrequent that the anesthesiologist must decide whether to proceed with a neuraxial procedure in an affected patient. Given the potential morbidity associated with general anesthesia for cesarean delivery, thoughtful consideration of which patients with thrombocytopenia are likely to have an increased risk of spinal epidural hematoma with neuraxial procedures, and when these risks outweigh the relative benefits is important to consider and to inform shared decision making with patients. Because there are substantial risks associated with withholding a neuraxial analgesic/anesthetic procedure in obstetric patients, every effort should be made to perform a bleeding history assessment and determine the thrombocytopenia etiology before admission for delivery. Read More