Background: Asthma exacerbation and thrombocytopenia during pregnancy present significant anesthetic challenges, particularly when urgent cesarean delivery is required. In addition, acute asthma exacerbation may compromise maternal oxygenation and necessitate immediate airway control. In such complex conditions, anesthetic management must be individualized to optimize maternal and fetal outcomes.

Case Illustration: We report the case of a 26-year-old pregnant woman (G4P1021) at 38 weeks and 4 days of gestation who was referred with premature rupture of membranes, acute asthma exacerbation, and severe thrombocytopenia. On admission, the patient had mild wheezing, respiratory rate of 24 breaths per minute, and oxygen saturation ranging from 93–96% on room air. Laboratory evaluation revealed severe thrombocytopenia with a platelet count of 38 × 10⁹/L and mild anemia (hemoglobin 9.7 g/dL). Preoperative optimization included nebulized salbutamol and intravenous corticosteroids. Due to the high risk of spinal or epidural hematoma and the potential for respiratory deterioration, general anesthesia with rapid sequence induction and intubation was selected. Ketamine and propofol were used for induction to provide bronchodilation, hemodynamic stability, and reduced airway reactivity. Anesthesia was maintained with propofol infusion, fentanyl, and rocuronium. The cesarean delivery proceeded uneventfully without intraoperative bronchospasm or hemodynamic instability.

Conclusion:  This case demonstrates that in obstetric emergencies complicated by acute asthma exacerbation and severe thrombocytopenia, general anesthesia can provide safer airway control and hemodynamic stability when regional anesthesia is contraindicated.