Intrapartum care for women on full anticoagulation.
Women requiring full anticoagulation in pregnancy and labour present their care providers with complex management problems, particularly during the peripartum period. Available guidelines often fail to address the practical issues of balancing the risks of recurrent thrombotic events and haemorrhage during labour. This is especially the case in women at high risk of recurrent thromboembolism, in whom the usually recommended temporary peripartum reduction in the level of anticoagulation may be considered unsafe. In order to achieve a satisfactory outcome without undue intervention, multidisciplinary management involving obstetricians, haematologists and anaesthetists is essential. Intrapartum care plans should be made during pregnancy to address the conduct of labour and delivery, anticoagulation, analgesia in labour and the management of any arising obstetric, anaesthetic or haematological complications. In the following we address the practical issues requiring particular attention, as well as management options, in fully anticoagulated patients using a clinical case for illustration.
Department of Obstetrics and Gynaecology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK. andrea.akkad@doctors.org.uk
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Akkad
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Oppenheimer
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Mushambi
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Pavord