Labor epidural analgesia with severe thrombocytopenia

Thrombocytopenia in pregnancy could potentially lead to epidural hematoma and associated morbidity when neuraxial anesthesia is performed. We present a case of a 24-year-old parturient, who was otherwise healthy and without prior thrombocytopenia, who underwent epidural placement in the setting of undiagnosed severe thrombocytopenia. Her workup remained inconclusive, and the presumptive diagnosis of severe preeclampsia was made. She was given a platelet transfusion and underwent an uncomplicated spontaneous vaginal delivery. After recovery of her platelet count, the epidural catheter was safely removed approximately 60 hours after placement without any signs or symptoms of an epidural hematoma.