Spinal anesthesia for a preeclamptic patient with HELLP syndrome in the resource-limited area: A case report

Introduction and importance: Thrombocytopenia is a known clinical presentation as many studies revealed around 1% of pregnant ladies were found to have a platelet count below 100 × 109/L. The cut-off value for the administration of neuraxial anesthesia in thrombocytopenic mothers is still unclear. This case report aims to explain the anesthetic management of a case with an indication for emergency hysterotomy. Case presentation: A 35 years old woman (94 kg, 150 cm Gravida1, Para 0) 25 weeks parturient was presented with headache and epigastric pain of 03 days duration. A decision to terminate the pregnancy was reached. The patient was obese (BMI = 41.7kg/m2) and all airway parameters indicate anticipated difficult airway, in addition to this she had a history of productive cough of 04 days duration and short NPO time, so considering all these risks we proceeded with spinal anesthesia. Clinical discussion: Update data about the anesthetic management of a mother with HELLP syndrome who planned for a cesarean section is not clear regarding the best approach. Clinicians must be aware of signs and symptoms of subarachnoid hematoma and be ready for intervention when spinal anesthesia is to be chosen. Conclusion: Fine-needle spinal anesthesia for a parturient that has HELLP syndrome has less incidence of subarachnoid hematoma, considering that ongoing postoperative follow-up should be there as we did in our case. Highlights