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

• 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
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2014.04.013

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.