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 of bruising.