Neuraxial Procedures in Obstetric Patients With Thrombocytopenia

Publication Date: February 28, 2021
Last Updated: March 14, 2022

Recommendations

The Obstetric Patient With a Known Etiology of Thrombocytopenia by Prior Workup or Confirmed Diagnosis of Hypertensive Disorders of Pregnancya

1. Assess for history of bleeding associated with thrombocytopenia and confirm no visible signs of DIC such as bleeding from intravenous (IV) sites, catheters, wounds, or new mucocutaneous bleeding. (, )
706
a. For confirmed diagnosis of gestational thrombocytopenia or ITP, or confirmed diagnosis of hypertensive disorders of pregnancy (eg, preeclampsia):
  • i. If concern for a history of bleeding associated with thrombocytopenia or DIC (as described above), then it may be reasonable to avoid neuraxial procedures or seek expert hematologic evaluation before proceeding with the neuraxial procedure.
(C-LD, IIb)
706
  • ii. If the platelet count is ≥70,000 × 106 /L, then there is likely to be a low risk of spinal epidural hematoma and it is reasonable to proceed with a neuraxial procedure if clinically indicated.
(C-LD, IIa)
706
  • iii. If the platelet count is between 50,000 and 70,000 × 106 /L, then there may be scenarios when competing risks/benefits justify proceeding with a neuraxial procedure.
(C-LDIIb)
706
  • iv. If the platelet count is <50,000 × 106 /L, then there may likely be an increased risk of spinal epidural hematoma compared to a platelet count ≥70,000 × 106 /L and it may be reasonable to avoid neuraxial procedures.
(C-LD, IIb)
706
b. If clinical scenario is consistent with hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome, then it may be reasonable to verify platelet count within 6 hours of the planned neuraxial procedure. (C-LDIIb)
706

Overview

Title

Neuraxial Procedures in Obstetric Patients With Thrombocytopenia

Authoring Organization

Society for Obstetric Anesthesia and Perinatology