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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, Joachim W.

Editorial Board Member: / Bancalari, Eduardo / Milner, Anne / Genc, Mehmet R. / Chervenak, Frank A. / Chappelle, Joseph / Bergmann, Renate L. / Bernardes, J.F. / Bevilacqua, G. / Blickstein, Isaac / Cabero Roura, Luis / Carbonell-Estrany, Xavier / Carrera, Jose M. / D`Addario, Vincenzo / D'Alton, MD, Mary E. / Dimitrou, G. / Grunebaum, Amos / Hentschel, Roland / Köpcke, W. / Kawabata, Ichiro / Keirse, Marc J.N.C. / Kurjak M.D., Asim / Lee, Ben H. / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Romero, Roberto / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, Istvan / Vetter, Klaus / Winn, Hung N. / Young, Bruce K. / Zimmermann, Roland

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Online
ISSN
1619-3997
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In This Section
Volume 36, Issue 2 (Mar 2008)

Issues

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

Kyra Bernstein
  • 1Gaucher Clinic, Shaare Zedek Medical Center, Jerusalem, Israel
/ Abigail Baer
  • 2Gaucher Clinic, Shaare Zedek Medical Center, Jerusalem, Israel
/ Martine Pollack
  • 3Gaucher Clinic, Shaare Zedek Medical Center, Jerusalem, Israel
/ Dov Sebrow
  • 4Gaucher Clinic, Shaare Zedek Medical Center, Jerusalem, Israel
/ Deborah Elstein
  • 5Gaucher Clinic, Shaare Zedek Medical Center, Jerusalem, Israel
/ Alexander Ioscovich
  • 6Department of Anesthesiology, Shaare Zedek Medical Center, Jerusalem, Israel
Published Online: 2008-03-10 | DOI: https://doi.org/10.1515/JPM.2008.020

Abstract

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 <150,000/mm3 at delivery. A total of 166 births (1.6%) were recorded in women with thrombocytes <150,000/mm3 at delivery. Parturients with >150,000/mm3 at week 36 were separated post hoc (n=35; 21%) and the remaining parturients were divided as having <100,000/mm3 (n=30; 18%) or 101,000–150,000/mm3 (n=101; 60.5%). Epidural or spinal anesthesia was administered to 30% women with <100,000/mm3 whereas 56% women with >101,000/mm3 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 <100,000/mm3 (P=0.009). There were no statistically significant differences in mean birth weights. Women with thrombocytes <150,000/mm3 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.

Keywords: Apgar scores; blood products; delivery; maternal outcome; neonatal outcome; regional anesthesia; thrombocytopenia

About the article

Corresponding author: Deborah Elstein, PhD Gaucher Clinic Shaare Zedek Medical Center P.O. Box 3235 Jerusalem 91031 Israel Tel.: +972-2-655-5093 Fax: +972-2-651-7979


Received: 2007-07-01

Revised: 2007-11-05

Accepted: 2007-11-24

Published Online: 2008-03-10

Published in Print: 2008-03-01



Citation Information: Journal of Perinatal Medicine, ISSN (Online) 16193997, ISSN (Print) 03005577, DOI: https://doi.org/10.1515/JPM.2008.020. Export Citation

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[3]
Joost J. Van Veen, Timothy J. Nokes, and Mike Makris
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