title: Neuraxial Anesthesia in Parturients with Thrombocytopenia: A Multisite Retrospective Cohort Study.
abstract: BACKGROUND
  The primary aim of this study was to estimate the risk of neuraxial hematoma associated with neuraxial anesthetic procedures in thrombocytopenic parturients.
  
  
  METHODS
  A multicenter retrospective cohort study design was used to estimate the risk for spinal-epidural hematoma in parturients with a platelet count of <100,000/mm receiving neuraxial anesthesia and the risk of complications in thrombocytopenic parturients who receive general anesthesia.
  
  
  RESULTS
  No cases of spinal hematoma were observed in 102 thrombocytopenic parturients receiving epidural analgesia or 71 receiving spinal anesthesia. Including data from the previous published series (total n = 499), the exact binomial 95% confidence interval for the risk of spinal-epidural hematoma was 0% to 0.6%. Given the small number of patients at each specific platelet count, the theoretical risks at individual platelet count strata are presented. Overall aggregate serious morbidity rate in women who received general anesthesia secondary to thrombocytopenia was 6.5% (95% confidence interval, 2.1%-14.5%).
  
  
  CONCLUSIONS
  Our work supports the relative maternal safety of neuraxial anesthesia in parturients with mild thrombocytopenia and estimates the maternal complication rate associated with the avoidance of neuraxial anesthesia. Remaining uncertainties at lower platelet counts make a national "low platelet" registry critical to a more accurate assessment of the risk of epidural hematoma and would aid in standardization of anesthesia practice.
authors.affiliation: From the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Medical University of South Carolina, Charleston, South Carolina; Department of Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts; Department of Anesthesia, Medical University of South Carolina, Charleston, South Carolina; Department of Anesthesiology, Tufts University Medical Center, Boston, Massachusetts; and Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Temple University and Shriners Hospital Pediatric Research Center, Philadelphia, Pennsylvania.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Goodier
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Lu
authors.forename: Latha
authors.initials: L
authors.lastname: Hebbar
authors.forename: B Scott
authors.initials: BS
authors.lastname: Segal
authors.forename: Laura
authors.initials: L
authors.lastname: Goetzl
mesh_terms: D000773:Anesthesia, Obstetrical / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D010976:Platelet Count / Q000379:methods; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood* / Q000175:diagnosis; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000097:blood* / Q000150:complications* / Q000175:diagnosis