Complex Alternative Labor Analgesia & Hemorrhage Management

Proposal Number:


Proposal Type:

Medically Challenging Case Report Poster 


Monica DiLorenzo  
Mount Sinai Hospital


Daniel Katz  
Icahn School of Medicine at Mount Sinai


A 41 year old female G8P7007 presented to labor and delivery at 39 weeks 0 days gestation for induction of labor due to immune thrombocytopenic purpura (ITP). She requested labor analgesia, with a preference for an epidural, as she had had them twice in the past. A platelet count and viscoelastic testing were obtained and it was determined that the risks of neuraxial analgesia outweighed the benefits, resulting in her choice of nitrous oxide for pain management. Following vaginal delivery, the patient experienced a rapid post-partum hemorrhage, which anesthesia and obstetrics treated in the setting of ITP. At the conclusion of her care, the patient compared various forms of labor analgesia, offering a unique insight across eight deliveries, including epidural analgesia, no medical analgesia, and nitrous oxide. The case presented unique challenges for pain management and hemorrhage management in the setting of a known coagulopathy.

Professional Category:



Pain Management

Enter up to two references.

1. Nunert, C., Lim, W., Crowther, M., Cohen, A., Solberg, L., & Crowther, M. A. (2011). The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood, 117(16), 4190-4207. Accessed May 20, 2019.
2. Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. 2017 Oct;130(4):e168-e186.