My Daily Domestic Diigolet 03/28/2008

Both spinal and epidural
anaesthesia are contraindicated when the patient has a significant coagulopathy
or thrombocytopenia. Pre-eclampsia can reduce both the quantity and quality of
platelets. These patients may also have hepatic dysfunction and be treated with
aspirin or thrombo-embolic prophylaxis. Although there are no studies to
support the idea, intuitively it would seem safer to choose spinal anaesthesia
with a small-gauge needle rather than the larger epidural needle in patients
with potential or actual mild platelet impairment.