Acute Asthma Exacerbation and Thrombocytopenia in Pregnancy: An Emergency Cesarean Case Report

Abstract

Background : Asthma exacerbation and thrombocytopenia in pregnancy present major anesthetic challenges, particularly during emergency cesarean delivery. While general anesthesia (GA) is often linked with higher respiratory risk compared to regional anesthesia (RA), it may be safer in cases of respiratory compromise, severe thrombocytopenia, or urgent surgical timelines. Such scenarios require individualized anesthetic planning and multidisciplinary coordination.

Case Illustration : We report a 26-year-old woman (G4P1021) at 38 weeks and 4 days of gestation, referred with premature rupture of membranes, acute asthma exacerbation, and severe thrombocytopenia (platelet count 38 × 10⁹/L). On admission, she had mild wheezing, oxygen saturation of 93–96% on room air, and mild anemia (Hb 9.7 g/dL). Preoperative optimization included nebulized salbutamol and intravenous corticosteroids. Given the high risk of neuraxial hematoma, GA with Rapid Sequence Induction and Intubation (RSII) was selected. Ketamine was used for its bronchodilatory and hemodynamic benefits, while propofol provided smooth induction with reduced airway reactivity. Anesthesia was maintained with propofol infusion, fentanyl, and rocuronium, avoiding histamine-releasing agents. The cesarean delivery proceeded uneventfully, with stable hemodynamics, effective airway control, and no intraoperative bronchospasm. Estimated blood loss was 1200 mL, managed with transfusion of packed red cells and colloids. Postoperatively, the patient was monitored in intensive care and recovered without respiratory or bleeding complications.

Conclusion :  This case highlights that in obstetric emergencies complicated by asthma exacerbation and severe thrombocytopenia, GA may provide safer airway control, stable hemodynamics, and favorable maternal–neonatal outcomes compared to RA.