What's your cut off?

[risnwb]

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What's your cut off platelet count for epidural and spinal placement in the obstetric population? In patients with preeclampsia vs. gestational thrombocytopenia? In a patient with anticipated difficult airway?

 

[GasGiver13]

80,000

 

[pgg]

A few good old threads on this topic, short answer is it depends. 🙂

http://forums.studentdoctor.net/showthread.php?t=663595
http://forums.studentdoctor.net/showthread.php?t=780407
http://forums.studentdoctor.net/showthread.php?t=853947

 

[cincincyreds]

A few good old threads on this topic, short answer is it depends. 🙂

http://forums.studentdoctor.net/showthread.php?t=663595
http://forums.studentdoctor.net/showthread.php?t=780407
http://forums.studentdoctor.net/showthread.php?t=853947

For me it depends on the situation. If I'm doing a C-section and the platelet count is below 50,000, I will avoid the spinal and actually transfuse platelets because they will be needed for the procedure. Above 50,000 as long as things are stable I would be okay with at least a spinal for C-section.

If I have a pre-eclamptic with a difficult airway, I really want to avoid a tube in these people so I would be willing to even have an epidural in them above 50,000 as long as the platelet count has been reasonably stable. If there had been an acute drop from lets say 100k-->50k, I would not place an epidural or spinal and instead topicalize the airway awake in this type of patient.

So the answer to your questions are it depends. You have to look at each situation indvidually and make sure you don't put mom in any extra risk than she is already in.