Elective section question

[TTCX2]

Hi all,

looking for advice for anyone whose recently had an elective section/ going for one. I am due in this Friday for an elective (due to previous preterm birth and GD in this pregnancy) and I’ve read about someone needing a general anaesthetic due to low platelets. I didn’t even consider this could be the case after they do my pre-op/ blood work. Is this rare for them to opt for this kind of anaesthetic as I 100% don’t want to be put to sleep for the birth.

any advice welcome, thank you🥰

This is very rare and they've got to be really, really low before they'll do a GA because of it. If you've had other bloods done in this pregnancy, you would (hopefully) already know if they were low enough to be a concern.

As far as I’m aware it is rare and only in extreme cases that you need to be uNader a general anaesthetic. When I was booked in for my elective (was an emergency in the end) I was told that unless there’s something wrong that they are already aware of then general would only be if the spinal block didn’t work (could still feel pain)

Thanks for getting back to me @valentinoandme, I naively hadn’t even considered any health issues flaring that might mean it was safer for me to be put under. I’m in tomorrow for blood pressure monitoring and repeat blood work as my ‘urea’ levels were slightly raised but I will obviously discuss any worries I have tomorrow but just had a slight panic. Thanks again!

Hi OP, low platelets are an issue with spinal anaesthesia as bleeding can occur at the site and cause haematoma to form which can cause damage to spinal cord. If they opt for a general anaesthetic then it's for a very good reason but hopefully your count will be normal and you'll be fine to have a spinal. Have you had low platelets before?

It’s very low for them to opt for general but they will explain the reasons for why they do it . Have you had your pre op? at mine they discussed all the different avenues- spinal, epidural and general and then they went through the different reasons as to why they do them. They reassured me that they don’t choose general lightly and it’s only in extreme situations when it’s far safer for you and the baby.

I had my bloods taken a day before my c section, the levels were worrying so they were repeated on the day of my c section. All the midwife’s, surgeon and anaesthetist were lovely and kind. They explain why they were repeating and what they were concerned about. They then held off everyone’s c section as they wanted to do mine first but needed to make sure it was safe to do so.
I was able to have the c section as it was just above borderline levels and it all went smoothly, my baby came out and I was able to have them lie on my chest with my dh there. Only thing is I felt awful and became more and more unwell thag my baby and dh had to leave.

With my next pregnancy there’s a big chance I’ll go under and it’s horrible to think I won’t be awake for that special moment with my baby but I know it’s for the best.

I help anaesthetists run the high risk anaesthetic clinic for women. Our trust guidelines are if it’s under 75 but above 50 with normal clotting factors then you are fine for a spinal. If your clotting factors are abnormal then it would have to be a ga. Under 50 would be a ga.

pregnancy does naturally lower platelets and can cause thrombocytopenia.

As per PP, platelets of about 50-75 is a fairly standard cut-off if the rest of the clotting screen is normal. Depends a bit on the speed at which they’re dropping and why they’re low too. Limit is slightly higher for an epidural because the needle is bigger. That said, we probably wouldn’t spend ages poking about if it turned out to be a difficult spinal if platelets were near the lower limit.

for a number of reasons GA is always a possibility, even for an elective section and even when it starts out under spinal. It’s not that common to need to convert, but it’s worth being clear that it is always a possibility.