title: The incidence of coagulopathy in pregnant patients with intrahepatic cholestasis: should we delay or avoid neuraxial analgesia?
abstract: OBJECTIVE
  To estimate the incidence of coagulopathy in patients with intrahepatic cholestasis inhepatic cholestasis of pregnancy (ICP).
  
  
  METHODS
  Retrospective cohort investigation.
  
  
  METHODS
  University medical center.
  
  
  METHODS
  The records of 319 parturients who met study inclusion criteria were reviewed for various laboratory values. The primary outcome was the incidence of abnormal hemostasis, defined as prothrombin time (PT) greater than 14.5 seconds (INR>1.2). The incidence of postpartum hemorrhage was evaluated as a secondary outcome.
  
  
  RESULTS
  The incidence (95% CI) of abnormal PT was 0% (0 to 1.8). Other coagulation tests [partial thromboplastin time (PTT) and platelet count] were also normal, even in study subjects with significant (>5 times) elevation of liver enzymes. The incidence of postpartum hemorrhage after vaginal delivery was 2.4% (4 of 208 pts) and 6.3% (7 of 111 pts) after Cesarean delivery.
  
  
  CONCLUSIONS
  Coagulation abnormalities are rare in pregnant patients with ICP, even when a strict criterion is utilized (INR<1.2). The use of neuraxial anesthesia and/or analgesia may not necessarily be delayed in parturients with isolated ICP.
authors.affiliation: Department of Anesthesiology, Northwestern University, Chicago, IL 60611, USA. Electronic address: adeleon@northwestern.edu.
authors.forename: Alexander
authors.initials: A
authors.lastname: DeLeon
authors.affiliation: Department of Anesthesiology, Northwestern University, Chicago, IL 60611, USA.
authors.forename: Gildasio S
authors.initials: GS
authors.lastname: De Oliveira
authors.affiliation: Department of Anesthesiology, Northwestern University, Chicago, IL 60611, USA.
authors.forename: Manoj
authors.initials: M
authors.lastname: Kalayil
authors.affiliation: Department of Anesthesiology, John H. Stroger, Jr., Hospital of Cook County, Chicago, IL 60612, USA.
authors.forename: Shweta
authors.initials: S
authors.lastname: Narang
authors.affiliation: Department of Anesthesiology, Northwestern University, Chicago, IL 60611, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: McCarthy
authors.affiliation: Department of Anesthesiology, Northwestern University, Chicago, IL 60611, USA.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Wong
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D016362:Analgesia, Obstetrical / Q000379:methods*; D001778:Blood Coagulation Disorders / Q000453:epidemiology*; D002585:Cesarean Section / Q000009:adverse effects; D002780:Cholestasis, Intrahepatic / Q000503:physiopathology*; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D010314:Partial Thromboplastin Time; D006473:Postpartum Hemorrhage / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D012189:Retrospective Studies
keywords: Cholestasis; Coagulopathy; Pregnancy