World’s first successful caesarean delivery performed at the lowest documented maternal platelet count (1,000/μl) with sustained maternal and neonatal outcomes

Abstract

Severe thrombocytopenia in pregnancy poses a major challenge for obstetric management, particularly when platelet counts fall below critical thresholds. Cesarean delivery under such conditions carries an exceptionally high risk of hemorrhage and maternal morbidity. Reports of successful maternal and neonatal outcomes at platelet counts around 1000/µL are not available in literature. We present this high-risk pregnancy case of a woman with rare O negative blood group, decreased fetal movements, severe oligohydramnios, fetal distress and an extremely low platelet count (1000/µL)-severe immune thrombocytopenia at 35 week 2 days gestational age (GA). Despite the unprecedented hematological risk, fetal distress mandated urgent intervention. The surgery was successful, resulting in the survival of both mother and neonate. Follow‑up over three years confirmed sustained maternal and neonatal health. This case represents a unique milestone in obstetric surgery worldwide-the first documented successful cesarean section performed during pregnancy at the lowest reported platelet count (1,000/µL) at the time of delivery, with long‑term survival of both mother and child. It highlights the importance of individualised management, timely intervention, meticulous preparation, and sound clinical judgment in achieving favourable outcomes despite extraordinary hematological risk.