Abstract

Introduction: WHO estimates indicate 65­75% prevalence of anemia in pregnancy inIndia, it defines Hb<7gm% as severe anemia. Thrombocytopenia is the most commonhematological abnormality encountered in pregnancy second only to anemia. These twoconditions presenting together in pregnancy pose multiple problems and theirmanagement is a challenge.

Case report: An unbooked 23yr old G2P1L1 with h/o previous LSCS presented with labour pains at 38weeks of gestation & was taken up for emergency LSCS . Investigations showed severeanemia and thrombocytopenia with NPO status of 4hrs. Accepted under ASA grade 3(E)risk with compatible blood kept ready. In view of anemia&thrombocytopenia (5.7Hb,platelet count 52,000) General anaesthesia with rapid sequence induction planned. Tw18G iv cannulas secured, aspiration prophylaxis given, preoxygenated and induced withpropofol, intubated with succinylcholine, maintained on N2O and O2& succinylcholine. Alive term male baby weighing 2.6kgs extracted. Perioperative hemodynamics was stablewith an uneventful recovery and extubation. Two units of PRBCs transfusedpostoperatively. Postoperative analgesia with inj.paracetamol 1gm intravenously 6

Conclusion: With severe anemia, cardiac decompensation may occur leading to circulatory failure,pulmonary oedema and maternal death. Low birth weight, increase in prematurity rateand intrauterine growth retardation in the newborn are reported when maternalhemoglobin levels are below 8.0g/dl.Thrombocytopenia and full stomach were additionalproblems encountered in this patient. Meticulous planning and management helped ingetting a good outcome in this patient.

* Dr Malathi C N Dr.Uma.GDr NaliniKotekar