DeLeon A, De Oliveira GS, Kalayil M, Narang S, McCarthy RJ, Wong CA. The incidence of coagulopathy in pregnant patients with intrahepatic cholestasis: should we delay or avoid neuraxial analgesia?
J Clin Anesth 2014;
26:623-7. [PMID:
25439411 DOI:
10.1016/j.jclinane.2014.04.013]
[Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 04/21/2014] [Accepted: 04/26/2014] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE
To estimate the incidence of coagulopathy in patients with intrahepatic cholestasis inhepatic cholestasis of pregnancy (ICP).
DESIGN
Retrospective cohort investigation.
SETTING
University medical center.
MEASUREMENTS
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.
MAIN 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.
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