🏳️🌈 During routine epidural or spinal anaesthesia, accidental puncture of epidural veins occurs in 1–18% of patients
🏳️🌈The incidence after epidural techniques is estimated to be in the order of 1:150,000 after epidural placement and 1:220,000 after spinal injection in the general population
🏳️🌈removal of epidural catheters posed an equal risk to insertion ( Van- dermeulen et al)
🏳️🌈Surgery on spinal haematoma should ideally be performed within 8–12 h of the identification of symptoms in order to improve the chances of recovery.
🏳️🌈The overall risk of death in those having general anaesthesia for caesarean section was quoted in 2007 as being just over 1:25,000.
🏳️🌈The levels of factors VII, VIII and fibrinogen increase and those of anticoagulation factors decrease, causing augmented coagulation and decreased fibrinolysis.
🏳️🌈There is no evidence to support routine full blood count (FBC) or coagu lation tests in women before the performance of a regional block in those who have had
🏴normal FBC results
🏴no bleeding history
🏴no signs or symptoms of liver disease
🏴no signs or symptoms of pre-eclampsia, abruption or clinical signs of disseminated intravascular coagulation
🏴no recent anticoagulant treatment.
🏳️🌈In women with known thrombocytopaenia, a Full Blood Count (FBC) should be checked within 24 h of a regional procedure.
🏴In women with mild to moderate pre-eclampsia, the course of the disease can be unpredictable and so FBC be checked within 6 h. In addition, coagulation tests should be performed if platelets are <100000/mcL or if there is abnormal liver function.
🏴In severe disease, FBC and clotting should be checked immediately before a procedure, as platelet levels in particular can decline rapidly.
🏴Women with pregnancy-induced hypertension alone do not require an FBC before a regional procedure
🏳️🌈Activated partial thromboplastin time ratio (APTTR) and international normalised ratio (INR) are slightly decreased in late pregnancy.
🏳️🌈In a patient who receives LMWH, if he/she is simultaneously taking NSAID+Aspirin, there is an increased risk if last dose of LMWH is between 12-24 hours; it further increases if last dose is <12 hours
🏳️🌈In patients with pre-eclampsia and platelet count between 75000-100000/mcL, there is an increased risk even if coagulation tests are normal; but it increases further if the counts has not been stable (= decreasing platelet count)
#obstetrics , #anesthesia , #coagulation , #anaesthesia
Reference: Abnormalities of Coagulation and Obstetric Anaesthesia, Hilary Swales, AAGBI Core Topics in Anaesthesia 2015
