In:
Obstetrics & Gynecology, Ovid Technologies (Wolters Kluwer Health), Vol. 133, No. 1 ( 2019-05), p. 67S-67S
Abstract:
Immune Thrombocytopenia (ITP) is characterized by preserved platelet function. The true magnitude of neuraxial hematoma risk in ITP parturients is unknown, yet obstetric neuraxial anesthesia (OBNA) is often withheld. The aim of this systematic review was to examine OBNA outcomes in ITP with platelet counts below 100x10(9)/L. METHODS: Relevant literature database-entries were searched to May 2018. Citations were independently screened and extracted in duplicate. Risk of bias was assessed using Newcastle-Ottawa Scale, NIH Case Series Assessment Tool and Joanna Briggs Institute Case Reports Checklist, as appropriate. Study authors were contacted for additional information. RESULTS: Our search yielded 954 titles/abstracts for screening with 62 full-texts reviewed, 26 included, and individual patient data obtained for 9. Of 291 individuals, 166 received OBNA; 61 at platelet counts below 80x10(9)/L. No neuraxial hematomas were reported. Median platelet counts were 80-93x10(9)/L. In a meta-analysis of 6 studies, platelets were higher in those with OBNA than those without [mean difference (MD), (95% confidence interval) 19 (3, 25) x10(9)/L; p 〈 0.00001], but did not differ between epidural and spinal anesthesia [MD 0.4 (-14, 20) x10(9)/L; p=0.86] . The “rule of three” places the upper bound of the 95% confidence interval for neuraxial hematoma risk at 1.8%. CONCLUSION: Our study further supports the quest to establish safety of OBNA in ITP at lower platelet counts. It highlights the reluctance to offer OBNA below the 80x10(9)/L threshold suggested by guidelines, yet based largely on theoretical presumption of risk. Given the rarity of OBNA in ITP at progressively lower platelet counts, an international registry could prove indispensable.
Type of Medium:
Online Resource
ISSN:
0029-7844
DOI:
10.1097/01.AOG.0000559051.26650.5b
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2019
detail.hit.zdb_id:
2012791-1
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