The incidence of coagulopathy in pregnant patients with intrahepatic cholestasis: should we delay or avoid neuraxial analgesia?

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 cri...

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Bibliographic Details
Published in:Journal of clinical anesthesia 2014-12, Vol.26 (8), p.623-627
Main Authors: DeLeon, Alexander, MD, De Oliveira, Gildasio S., MD, MSCI, Kalayil, Manoj, MD, Narang, Shweta, MD, McCarthy, Robert J., PharmD, Wong, Cynthia A., MD
Format: Article
Language:English
Subjects:
Academic Medical Centers
Adult
Analgesia, Obstetrical - methods
Anesthesia & Perioperative Care
Blood Coagulation Disorders - epidemiology
Blood platelets
Body mass index
Cesarean section
Cesarean Section - adverse effects
Cholestasis
Cholestasis, Intrahepatic - physiopathology
Coagulopathy
Cohort Studies
Delivery, Obstetric - adverse effects
Delivery, Obstetric - methods
Enzymes
Female
Gallbladder diseases
Hemorrhage
Humans
Hypotheses
Incidence
Laboratories
Liver diseases
Obstetrics
Pain Medicine
Partial Thromboplastin Time
Patients
Postpartum Hemorrhage - epidemiology
Preeclampsia
Pregnancy
Pregnancy Complications - physiopathology
Retrospective Studies
Studies
Womens health
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Summary: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.
ISSN:0952-8180
1873-4529
DOI:10.1016/j.jclinane.2014.04.013