Epidural Blood Patch in Pregnancy

Contraindications and Precautions

The American College of Physicians and other medical societies do not list pregnancy as a contraindication to receiving an epidural blood patch (EBP), according to the 2023 multisociety consensus guidelines 1, 2, 3
Thrombocytopenia is a contraindication if the platelet count is <70,000 × 10⁶/L, but EBP can be safely performed with a platelet count ≥70,000 × 10⁶/L and normal platelet function 1, 2, 3
Anticoagulation is a contraindication if there is recent therapeutic anticoagulation without an appropriate washout period, and clinicians must follow guidelines regarding neuraxial injection in patients receiving antithrombotics 1, 2
Active infection is a contraindication, and caution should be exercised when considering EBP in febrile patients or those with systemic signs of infection 1, 2, 3

The American Society of Anesthesiologists recommends proceeding with EBP if the platelet count is ≥70,000 × 10⁶/L with normal platelet function, there is no active systemic infection or fever, and appropriate timing relative to anticoagulation (if applicable) 1, 2, 3
The American Society of Anesthesiologists recommends deferring or avoiding EBP if the platelet count is <70,000 × 10⁶/L or platelet dysfunction is present, there is active fever or signs of systemic infection, or recent therapeutic anticoagulation without an appropriate washout period 1, 2, 3

Prophylactic EBP is not routinely recommended despite pregnancy, as not every patient develops post-dural puncture headache (PDPH), and routine prophylaxis exposes some to unnecessary risks 1, 5
The timing of EBP matters, with procedures performed >48 hours after dural puncture showing higher permanent relief rates compared to those within 24 hours 1
The postpartum period warrants particular vigilance for neurological complications, but these are related to the initial dural puncture rather than the EBP itself 6