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General anaesthesia for caesarean delivery for thrombocytopaenia: findings from an obstetric airway management registry
Background Regional anesthesia (RA) is preferred for cesarean section (CS). In women at risk of spinalepidural hematoma, thrombocytopenia should be excluded. In South Africa, this investigation is often unavailable due to the absence of urgent laboratory services. Methods The obstetric airway manage...
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| Format: | Thesis |
| Language: | Eng |
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Department of Anaesthesia and Perioperative Medicine
2024
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| _version_ | 1867613186559049728 |
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| access_status_str | Open Access |
| author | Seymour, Lisa |
| author2 | Fernandes, Nicole |
| author_browse | Fernandes, Nicole Seymour, Lisa |
| author_facet | Fernandes, Nicole Seymour, Lisa |
| author_sort | Seymour, Lisa |
| collection | Thesis |
| description | Background Regional anesthesia (RA) is preferred for cesarean section (CS). In women at risk of spinalepidural hematoma, thrombocytopenia should be excluded. In South Africa, this investigation is often unavailable due to the absence of urgent laboratory services. Methods The obstetric airway management registry (ObAMR) is currently active across all training institutions affiliated with the University of Cape Town, including secondary and tertiary level obstetric services. This retrospective multicenter observational study aimed to determine the incidence of general anesthesia (GA) performed either because thrombocytopenia (platelet count < 75 x 109 /L. In group Tbcp NE, 46/52 (88.5%) platelet counts could be traced. The median (interquartile range) platelet count was 178 x 109 /L (93-233 x 109 /L), and > 75 x 109 /L in 41/46 (89.1%) patients. In the 5/46 patients with thrombocytopenia, 2 had hemolysis elevated liver enzymes and low platelets (HELLP) syndrome, 2 had antepartum hemorrhage with preeclampsia, and 1 had isolated thrombocytopenia with preeclampsia. Conclusions In 17% of patients the indication for GA was thrombocytopenia. Many patients received GA because a platelet count was unavailable at the time of obstetric surgery. The importance of early laboratory assessment, when available, should be emphasized. Most patients in whom thrombocytopenia had not been excluded, and whose hypertension was uncomplicated, had a platelet count >75 x 109 /L. After careful decision consideration of risk and benefit, there may be circumstances in which the clinician justifiably opts for RA when a platelet count is indicated but unavailable. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/40331 |
| institution | University of Cape Town (South Africa) |
| language | Eng |
| last_indexed | 2026-06-10T12:32:08.355Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2024 |
| publishDateRange | 2024 |
| publishDateSort | 2024 |
| publisher | Department of Anaesthesia and Perioperative Medicine |
| publisherStr | Department of Anaesthesia and Perioperative Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/40331 General anaesthesia for caesarean delivery for thrombocytopaenia: findings from an obstetric airway management registry Seymour, Lisa Fernandes, Nicole Hofmeyr Michael Anaesthesia and Perioperative Medicine Background Regional anesthesia (RA) is preferred for cesarean section (CS). In women at risk of spinalepidural hematoma, thrombocytopenia should be excluded. In South Africa, this investigation is often unavailable due to the absence of urgent laboratory services. Methods The obstetric airway management registry (ObAMR) is currently active across all training institutions affiliated with the University of Cape Town, including secondary and tertiary level obstetric services. This retrospective multicenter observational study aimed to determine the incidence of general anesthesia (GA) performed either because thrombocytopenia (platelet count < 75 x 109 /L. In group Tbcp NE, 46/52 (88.5%) platelet counts could be traced. The median (interquartile range) platelet count was 178 x 109 /L (93-233 x 109 /L), and > 75 x 109 /L in 41/46 (89.1%) patients. In the 5/46 patients with thrombocytopenia, 2 had hemolysis elevated liver enzymes and low platelets (HELLP) syndrome, 2 had antepartum hemorrhage with preeclampsia, and 1 had isolated thrombocytopenia with preeclampsia. Conclusions In 17% of patients the indication for GA was thrombocytopenia. Many patients received GA because a platelet count was unavailable at the time of obstetric surgery. The importance of early laboratory assessment, when available, should be emphasized. Most patients in whom thrombocytopenia had not been excluded, and whose hypertension was uncomplicated, had a platelet count >75 x 109 /L. After careful decision consideration of risk and benefit, there may be circumstances in which the clinician justifiably opts for RA when a platelet count is indicated but unavailable. 2024-07-04T14:03:38Z 2024-07-04T14:03:38Z 2023 2024-06-03T13:32:46Z Thesis / Dissertation Masters MMed http://hdl.handle.net/11427/40331 Eng application/pdf Department of Anaesthesia and Perioperative Medicine Faculty of Health Sciences |
| spellingShingle | Anaesthesia and Perioperative Medicine Seymour, Lisa General anaesthesia for caesarean delivery for thrombocytopaenia: findings from an obstetric airway management registry |
| thesis_degree_str | Master's |
| title | General anaesthesia for caesarean delivery for thrombocytopaenia: findings from an obstetric airway management registry |
| title_full | General anaesthesia for caesarean delivery for thrombocytopaenia: findings from an obstetric airway management registry |
| title_fullStr | General anaesthesia for caesarean delivery for thrombocytopaenia: findings from an obstetric airway management registry |
| title_full_unstemmed | General anaesthesia for caesarean delivery for thrombocytopaenia: findings from an obstetric airway management registry |
| title_short | General anaesthesia for caesarean delivery for thrombocytopaenia: findings from an obstetric airway management registry |
| title_sort | general anaesthesia for caesarean delivery for thrombocytopaenia findings from an obstetric airway management registry |
| topic | Anaesthesia and Perioperative Medicine |
| url | http://hdl.handle.net/11427/40331 |
| work_keys_str_mv | AT seymourlisa generalanaesthesiaforcaesareandeliveryforthrombocytopaeniafindingsfromanobstetricairwaymanagementregistry |