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Blood Tests Prior to Regional Techniques in Intrauterine Fetal Death
Abstract Number: 119
Abstract Type: Other
Introduction: Intrauterine fetal death (IUFD) can cause maternal thrombocytopenia and coagulopathy. These pathologies are relevant to the safety of central neuraxial blockade for labor and delivery. There is currently no national guidance in the United Kingdom to inform hematological investigation prior to a regional procedure. We conducted a web-based survey to investigate the practice of anesthesiologists in training.
Method: 256 residents from four major teaching hospital rotations in the UK were surveyed in August 2009. Recipients were asked which investigations they performed in the context of IUFD, whether their choice of investigation was dependent on the interval from diagnosis to request for regional analgesia and whether they were aware of any guidelines for this practice in their unit. A single e-mail reminder was sent. Results were collated with online software.
Results: The response rate was 55% (140/256). 69% of respondents stated that they always quantified platelet count or coagulation indices, 30% "sometimes" and 1% "never". Of those respondents who perform investigations either always or sometimes, 96% quantify platelet count and coagulation, 2% platelets only, 2% coagulation only. In those residents who investigated "Sometimes", 33% said their decision depended only on the time interval since diagnosis of IUFD (Figure 1). 81% of residents were unaware of a departmental policy for neuraxial blockade in the presence of IUFD.
Discussion: The reported incidence of coagulation abnormalities with uncomplicated IUFD is 3.2% - 4% (Ref 2, 3). This risk increases in the presence of abruption, chorioamnionitis or uterine perforation and has the potential to preclude the safe conduct of regional techniques.
Conclusion: Our survey demonstrated that hematological investigation in IUFD is performed largely at the discretion of individual residents and subject to substantial variability. There is a paucity of guidance to inform the conduct of neuraxial blockade in the presence of an IUFD. Departments should consider issuing local guidance to assist the decision making process.
1) Perinatal Mortality 2007 www.cemach.org.uk
2) Can J Anaesth 1996; 43: 1237-43
3) J Womens Health 2009; 18: 469-74