What is the evidence that
initiating an epidural anesthetic in a woman with a platelet count <100,000 mm−3 may be safe?
The safety of initiating an epidural anesthetic
when the platelet count is less than 100,000 mm−3 is
supported by the results of three retrospective studies. In the largest study,
Beilin et al. (1997) reviewed the medical records of 15,919 consecutive
parturients during a 3-year period. They found 80 women who presented with a
platelet count less than 100,000 mm−3, 30 of whom received an epidural anesthetic without sequelae.
These 30 women had certain character-istics in common. The platelet count did
not decrease around the time of epidural catheter placement and there was no
clinical evidence of bleeding. In that study, 5 women were denied an epidural
anesthetic because of a decreasing platelet count and 2 women because of evidence