Published: 2017-01-31

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

Shivali Panwar, Divya Arora, Anu Kapur, Kirti Nath Saxena


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.


Labour analgesia, Sterile water injection, Thrombocytopenia

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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.