Staged anesthesia for cesarean delivery in a parturient with a history of Wilson disease: a case report
Abstract
<title>Abstract</title> <p>Background: Cesarean anesthesia in parturients with Wilson disease is rarely reported, particularly in the presence of cirrhosis, portal hypertension, thrombocytopenia, and impaired coagulation. These conditions complicate the choice between neuraxial and general anesthesia while maternal and fetal risks must be balanced. Case presentation: A 34-year-old woman at 35 weeks and 5 days of gestation, with a history of Wilson disease diagnosed at another institution, cirrhosis, esophagogastric varices, splenomegaly, neurologic involvement, and chronic thrombocytopenia, was admitted with persistent lower abdominal pain and progressive hepatic dysfunction. Preoperative testing showed a platelet count of 58×10^9/L, prothrombin time of 16.5 s, prothrombin activity of 62%, and total bilirubin of 91.4 μmol/L. Because neuraxial anesthesia was considered unfavorable, a staged anesthetic strategy was used. Before fetal delivery, spontaneous ventilation was maintained with face-mask oxygen, intravenous esketamine, and layer-by-layer surgical infiltration with lidocaine. After delivery, anesthesia was converted to general anesthesia using a laryngeal mask airway. A 2580-g female neonate was delivered with Apgar scores of 10 at 1, 5, and 10 min. Postoperatively, the patient developed persistent anemia, bloody abdominal drainage, hypoalbuminemia, and progressive conjugated hyperbilirubinemia and received blood products and human albumin. Drainage gradually decreased, and mother and infant were discharged together on postoperative day 8. <h4>Conclusions:</h4> This case illustrates an individualized staged anesthetic approach for cesarean delivery in a parturient with advanced liver disease, thrombocytopenia, and coagulation impairment. This strategy achieved favorable immediate maternal and neonatal clinical outcomes, although its safety and generalizability require further evaluation.</p>
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