Background: An average of 140,000 epidurals are administered annually in the UK for obstetric analgesia. Vertebral canal haematoma (VCH) is one of the detrimental complications, with incidence of 1 in 168,000 cases. There is no robust estimate of VCH risk in the presence of an inherited bleeding disorder (IBD).

Aims: Perform an observational study of management and outcomes of obstetric epidural and spinal analgesia/anaesthesia in women with inherited bleeding disorder.

Methods: Retrospective review of electronic patient notes of women who were managed by the multidisciplinary Obstetric-Haemophilia clinic.

Results: Total of 132 women received intrapartum neuraxial analgesia/ anaesthesia (45 carriers of haemophilia A&B, 37 von Willebrand disease, 31 factor XI deficiency, , 13 platelet function disorders, two factor VII deficiency, two unclassified bleeding disorders, two factors XI deficiency. All women (100%) were seen in third trimester of pregnancy in the multidisciplinary clinic to confirm pain relief options and haemostasis plan. Bleeding risk was assessed using women’s bleeding phenotype and/or factor level, thromboelastography. Prophylactic haemostatic cover was planned accordingly. Intravenous tranexamic acid was given in all women prior to insertion of neuraxial analgesia/anaesthesia. Other treatments used included desmopressin, clotting-factor concentrate and platelets as appropriate;  required in 22 cases. Incidence of adverse events was 5.3% (n=7), similar to that found in the general population, including inadequate anaesthesia (2), bloody tap (2), hypotension (2) and a possible dural puncture.  All complications were resolved with simple measures. There were no reports of spinal/epidural haematoma or  long-term complications.

Conclusions: Neuraxial analgesia/ anaesthesia can be provided safely to women with inherited bleeding disorders with contingent prior assessment of bleeding risk with appropriate and adequate haemostatic cover.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/obstetric-analgesia-and-anaesthesia-in-women-with-inherited-bleeding-disorders/