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Thrombocytopenia Epidural Decision Labour — FRCA Final MCQ

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HardObstetric AnaesthesiaThrombocytopenia Epidural Decision LabourFRCA Final

A 35-year-old woman (ASA I, 55 kg) at 38 weeks gestation is in spontaneous labour and requests epidural analgesia. She has a platelet count of 72 × 10⁹/L from gestational thrombocytopenia. Previous counts were: 120 at booking, 95 at 28 weeks, 72 now. Is epidural insertion safe?

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Correct answer: D — The decision depends on the platelet trend, function, and a risk-benefit discussion with the patient

There is no universally agreed absolute platelet count threshold for neuraxial blockade. Traditional teaching cites 80 × 10⁹/L as a commonly used threshold, but this is not evidence-based. The decision should consider: (1) the platelet TREND (this patient shows a downward trend – 120→95→72 – which may continue), (2) platelet FUNCTION (gestational thrombocytopenia produces normally functioning platelets, unlike ITP or HELLP), (3) alternative analgesic options (remifentanil PCA), and (4) the risks of NOT having an epidural (emergency GA risk). A shared decision with full informed consent and documentation is required. Many anaesthetists would proceed with caution at a platelet count of 70-80 in gestational thrombocytopenia.

Reference: OAA/AAGBI – 2013 – Obstetric anaesthetic services; Association of Anaesthetists – 2013 – Regional and coagulation