Background Thrombocytopenia has been considered a relative or even absolute contraindication to neuraxial techniques due to the risk of epidural hematoma. There is limited literature to estimate the risk of epidural hematoma in thrombocytopenic parturients. The authors reviewed a large perioperative database and performed a systematic review to further define the risk of epidural hematoma requiring surgical decompression in this population. Methods The authors performed a retrospective cohort study using the Multicenter Perioperative Outcomes Group database to identify thrombocytopenic parturients who received a neuraxial technique and to estimate the risk of epidural hematoma. Patients were stratified by platelet count, and those requiring surgical decompression were identified. A systematic review was performed, and risk estimates were combined with those from the existing literature. Results A total of 573 parturients with a platelet count less than 100,000 mm–3 who received a neuraxial technique across 14 institutions were identified in the Multicenter Perioperative Outcomes Group database, and a total of 1,524 parturients were identified after combining the data from the systematic review. No cases of epidural hematoma requiring surgical decompression were observed. The upper bound of the 95% CI for the risk of epidural hematoma for a platelet count of 0 to 49,000 mm–3 is 11%, for 50,000 to 69,000 mm–3 is 3%, and for 70,000 to 100,000 mm–3 is 0.2%. Conclusions The number of thrombocytopenic parturients in the literature who received neuraxial techniques without complication has been significantly increased. The risk of epidural hematoma associated with neuraxial techniques in parturients at a platelet count less than 70,000 mm–3 remains poorly defined due to limited observations.

Neuraxial analgesia has been established as the standard of care for labor analgesia. However, patients presenting with coagulopathy require anesthesiologists to explore alternate analgesic techniques. Systemic opioids may result in neonatal respiratory depression, and inhaled nitrous oxide may lead to nausea, vomiting, and over sedation and may not be readily available in all labor and delivery units. In this case report, we describe a case where posterior quadratus lumborum blocks provided effective analgesia in a parturient with Hemophilia A during the first stage of labor.

No abstract

No abstract