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Background and Aims Gestational thrombocytopenia (GT) occurs in 5%-10% of women during the 3rd trimester or the immediate postpartum period. Coronavirus disease 2019 (COVID-19) related thrombocytopenia (CT) occurs in 5-40% of non-pregnant patients, and there are reports of its occurrence in pregnancy. GT increases the risk of peripartum haemorrhage and epidural hematoma following neuraxial techniques.

Methods We describe the management of a postpartum woman with CT and an epidural catheter in situ.

Results A 37-year-old primigravida, 37w+5d, was admitted to the labour ward. Pregnancy was uneventful and laboratory results of the admission were normal (table 1). An epidural catheter was placed for labour analgesia. Nine hours later, due to non-reassuring fetal status, an emergency C-section was performed under general anaesthesia, with an unremarkable intraoperative period. In the recovery unit, the patient started complaining of dyspnea and cough. Laboratory test results showed a positive PCR test for SARS-CoV-2 and new onset thrombocytopenia (56,000/μl). She required oxygen by nasal cannula for 48 hours and was closely monitored for the onset of neurological symptoms. The epidural catheter was removed when the platelet count became normal (72 hours later). The remaining postpartum period was uneventful.

Conclusions This case emphasizes that CT may develop quickly and present before respiratory symptoms. In this case, the existence of a normal complete blood count on admission helped establish the onset of thrombocytopenia. A falling platelet count indicates a worsening of COVID, thus reinforcing the importance of close monitoring and follow-up. Other causes of thrombocytopenia, both pregnancy and non-pregnancy related should be ruled out.