Coagulation screening before epidural analgesia in pre‐eclampsia

Abstract

A questionnaire survey of current practice at a small cross‐section of obstetric units, covering 22% of all United Kingdom deliveries, revealed a marked lack of standard practice regarding requests for coagulation screens on pre‐eclamptic patients who require epidural procedures. A retrospective audit was therefore carried out on 434 coagulation screens requested for pre‐eclamptic patients in whom epidural analgesia might have been considered. Borderline abnormalities of coagulation were found in only 10 patients (2%). Platelet counts of less than 150 × 109/litre were present in 28% of cases. ‘Significant’ thrombocytopenia (< 100 × 109/litre) and all coagulation abnormalities were only encountered in severe pre‐eclampsia (diastolic blood pressure of greater than 110 mmHg and proteinuria of ++ or greater). Furthermore, coagulation abnormality was always associated with a reduced platelet count (mean, 97 × 109/litre). This study would therefore support anaesthetic practice which restricted any requests for coagulation testing to severe pre‐eclamptic patients only. For these patients first line testing could be limited to a platelet count. Copyright © 1991, Wiley Blackwell. All rights reserved