Abstract Number: OC 62.3
Meeting: ISTH 2021 Congress
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.
To cite this abstract in AMA style:Turan O, Kasapoglu D, Abdi Z, Abdul-Kadir R. Obstetric Analgesia and Anaesthesia in Women with Inherited Bleeding Disorders [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/obstetric-analgesia-and-anaesthesia-in-women-with-inherited-bleeding-disorders/. Accessed December 3, 2021.
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