Sterile water injection labour analgesia in a parturient with preeclampsia with thrombocytopenia


  • Shivali Panwar Department of Anaesthesiology and Critical Care, North DMC Medical College, Hindu Rao Hospital, New Delhi, India
  • Divya Arora Department of Anaesthesiology and Critical Care, Hindu Rao Hospital, New Delhi, India
  • Anu Kapur Department of Anaesthesiology and Critical Care, Hindu Rao Hospital, New Delhi, India
  • Kirti Nath Saxena Department of Anaesthesiology and Critical Care, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India



Labour analgesia, Sterile water injection, Thrombocytopenia


Pregnancy induced hypertension is one of the most common causes of maternal morbidity and mortality. A G2L1A1 female with period of gestation 36 weeks presented in our hospital with early labour pains. She was a known case of pregnancy induced hypertension with thrombocytopenia and had been operated on the lumbar spine for Potts spine. She was administered intradermal sterile water injection labour analgesia every 3 hours. The labour was uneventful and patient had a normal vaginal delivery of a male baby. The postnatal course was uneventful and patient was satisfied with the labour analgesia.


Gibson B, Hunter D, Neame PB, Kelton JG. Thrombocytopenia in preeclampsia and eclampsia. Sem Thromb Haemostas. 1982;8:234-47.

Giles C, Inglis TCM. Thrombocytopenia and macro thrombocytosis in gestational hypertension. Br J Obstet Gynecol. 1981;88:1115-9.

Katz VL, Thorp JM, Rozas L, Bowes WA. The natural history of thrombocytopenia associated with preeclampsia. Am J Obstet Gynecol. 1990;163:1142-43.

Vigil-De Gracia P, Montufar-Rueda C, Ruiz J. Expectant management of severe preeclampsia and preeclampsia superimposed on chronic hypertension between 24 and 34 weeks gestation. Eur J Obstet Gynecol Reprod Biol. 2003;107:24-7.

O΄Brien WF, Saba HI, Knuppcl RA. Alterations in platelet concentration and aggregation in normal pregnancy and preeclampsia. Am Obstet Gynecol. 1986;1(55):486-90.

Burrows RE, Hunter DJS, Andrew M. A retrospective study investigating mechanism of thrombocytopenia in preeclampsia. Obstet Gynecol. 1987:70:334-8.

Fitzgerald DJ, Entman SS, Mulloy K. Decreased prostacyclin biosynthesis preceding the clinical manifestation of pregnancy induced hypertension. Circulation. 1987;75:956-63.

Redman CWG, Bonnar J, Beilin L. Early platelet consumption in preeclampsia. Br Med J. 1978;i:467-70.

Douglas MJ. The use of neuraxial anaesthesia in parturients with thrombocytopenia: what is an adequate platelet count? In: Halpern SH, Douglas MJ eds, Evidence based obstetric anaesthesia. Blackwell Publishing, Massachusetts. 2005: 165-77.

Sharrock NE, Urquhart B, Mineo R. Extradural anaesthesia in patients with previous lumbar spine surgery. Br J Anaesth. 1990;65:237-9.

Feldstein G, Ramanathan S. Obstetric lumbar epidural anaesthesia in patients with previous posterior spinal fusion for kyphoscoliosis. Anesth Analg. 1985;64:83-5.

Melzack R, Wall PD. Pain mechanisms: A new theory. Science. 1965;150:971-9.

Hutton EK, Kasperink M, Rutten M, Reitsma A, Wainman B. Sterile water injection for labour pain: a systematic review and meta analysis of randomized controlled trials. BJOG. 2009;116:1158-66.

Saxena KN, Nischal H, Batra S. Intracutaneous injections of sterile water over the sacrum for labour analgesia. Indian J Anaesth. 2009;53:169-73.

Panwar S, Saxena KN. Sterile water block labor analgesia in a parturient with ventriculoperitoneal shunt in situ. J Obstet Anaesth Crit Care. 2016;6:19-21.






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