General anaesthesia for caesarean delivery for thrombocytopaenia: findings from an obstetric airway management registry

Seymour, Lisa

General anaesthesia for caesarean delivery for thrombocytopaenia: findings from an obstetric airway management registry

Thesis / Dissertation

2023

Abstract

Background Regional anesthesia (RA) is preferred for cesarean section (CS). In women at risk of spinalepidural hematoma, thrombocytopenia should be excluded. In South Africa, this investigation is often unavailable due to the absence of urgent laboratory services. Methods The obstetric airway management registry (ObAMR) is currently active across all training institutions affiliated with the University of Cape Town, including secondary and tertiary level obstetric services. This retrospective multicenter observational study aimed to determine the incidence of general anesthesia (GA) performed either because thrombocytopenia (platelet count < 75 x 109 /L. In group Tbcp NE, 46/52 (88.5%) platelet counts could be traced. The median (interquartile range) platelet count was 178 x 109 /L (93-233 x 109 /L), and > 75 x 109 /L in 41/46 (89.1%) patients. In the 5/46 patients with thrombocytopenia, 2 had hemolysis elevated liver enzymes and low platelets (HELLP) syndrome, 2 had antepartum hemorrhage with preeclampsia, and 1 had isolated thrombocytopenia with preeclampsia. Conclusions In 17% of patients the indication for GA was thrombocytopenia. Many patients received GA because a platelet count was unavailable at the time of obstetric surgery. The importance of early laboratory assessment, when available, should be emphasized. Most patients in whom thrombocytopenia had not been excluded, and whose hypertension was uncomplicated, had a platelet count >75 x 109 /L. After careful decision consideration of risk and benefit, there may be circumstances in which the clinician justifiably opts for RA when a platelet count is indicated but unavailable.

Keywords

Anaesthesia and Perioperative Medicine

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