Anaesthesia and the antiphospholipid syndrome: a review of 20 obstetric patients.
The case notes of 20 obstetric patients with antiphospholipid syndrome delivering over a 4-year period were reviewed retrospectively. There were complete details for 22 singleton pregnancies. Obstetric complications in the pregnancies under review were frequent. Nine (47%) of the 19 women whose pregnancies reached the third trimester were delivered by caesarean section. During seven of the pregnancies there was significant prolongation of the phospholipid-dependent coagulation tests secondary to lupus anticoagulant and/or anticardiolipin antibodies. Four of these women received epidural blockade without sequelae. This finding, however, cannot provide valid evidence for the safety or otherwise of epidural placement in this group of patients, since the series is small and the incidence of epidural haematoma is exceedingly rare in the obstetric population. Paradoxically, these patients are hypercoagulable. The estimated blood loss at these deliveries did not exceed 600 ml. Eleven women (55%) had a previous history of thrombosis. Two women had thrombotic episodes during their pregnancies and three had them post partum despite antithrombotic measures.
Department of Anaesthesia, St Thomas' Hospital, London, UK.
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Ringrose