Epidural anaesthesia for caesarean delivery in a woman with Fontan circulation and severe thrombocytopaenia

Fontan physiology poses unique anaesthetic challenges due to passive pulmonary circulation, preload dependence and elevated venous pressures. We present a case of a parturient in her 20s with Fontan circulation and severe thrombocytopaenia who successfully underwent elective caesarean delivery under epidural anaesthesia. Despite a platelet count <50×10⁹/L, reassuring thromboelastography findings and absence of bleeding history supported neuraxial anaesthesia with a multidisciplinary perioperative plan, including targeted platelet transfusion and continuous invasive monitoring. This case highlights the importance of individualised anaesthetic risk assessment, careful interpretation of coagulation studies and collaborative decision-making in high-risk obstetric patients. Our case supports the feasibility of epidural anaesthesia even in severely thrombocytopenic patients, particularly when general anaesthesia carries significant haemodynamic risk as in Fontan circulation and should not be excluded solely based on platelet count.