Coagulation screening before epidural analgesia in pre-eclampsia.
A questionnaire survey of current practice at a small cross-section of obstetric units, covering 22% of all United Kingdom deliveries, revealed a marked lack of standard practice regarding requests for coagulation screens on pre-eclamptic patients who require epidural procedures. A retrospective audit was therefore carried out on 434 coagulation screens requested for pre-eclamptic patients in whom epidural analgesia might have been considered. Borderline abnormalities of coagulation were found in only 10 patients (2%). Platelet counts of less than 150 x 10(9)/litre were present in 28% of cases. 'Significant' thrombocytopenia (less than 100 x 10(9)/litre) and all coagulation abnormalities were only encountered in severe pre-eclampsia (diastolic blood pressure of greater than 110 mmHg and proteinuria of + + or greater). Furthermore, coagulation abnormality was always associated with a reduced platelet count (mean, 97 x 10(9)/litre). This study would therefore support anaesthetic practice which restricted any requests for coagulation testing to severe pre-eclamptic patients only. For these patients first line testing could be limited to a platelet count.
Barker
P
P
Department of Anaesthetics, University Hospital of Wales, Cardiff, UK.
Callander
C C
CC
D015360:Analgesia, Epidural; D000773:Anesthesia, Obstetrical; D001777:Blood Coagulation / Q000502:physiology; D001780:Blood Coagulation Tests; D005260:Female; D006801:Humans; D008485:Medical Audit; D010976:Platelet Count; D011225:Pre-Eclampsia / Q000097:blood* / Q000150:complications; D011247:Pregnancy; D012189:Retrospective Studies