Needle Phobia in an Obstetric Patient
Abstract Number: S 50
Abstract Type: Case Report/Case Series
Needle phobia (NP) is a specific terror with diagnostic criteria. NP patients typically have a vasovagal response to needles or the mention of needles resulting in hypotension and/or syncope. Other symptoms include diaphoresis, pallor, nausea, respiratory disturbances, bradycardia, arrhythmias, seizure, and cardiac arrest and have resulted in 23 documented deaths.
A 30 year-old primigravida female at 40+2 weeks estimated gestational age presented for scheduled induction of labor. Her NP began at 12 years of age when she recalls being held down for a blood draw. She had treatment for NP multiple times as a teenager, and as an adult was previously on an anxiolytic and a beta-blocker without improvement in symptoms. She had also tried hypnotherapy without benefit.
The obstetric team planned for an induction of labor without IV access. The anesthesiologist on the labor deck at the time made multiple visits to discuss her NP and establish a therapeutic alliance with her, although she continued to decline an IV. After thirty hours of unsuccessful labor, a cesarean section recommendation was made for arrest of dilation/failed induction.
An IV was placed on the third attempt in the operating room with her consent, though she continued to refuse a regional technique. The patient developed tachycardia during IV placement which rapidly converted to bradycardia suggestive of a vasovagal reaction.
The obstetric patient with NP presents multiple challenges including difficulty in medication delivery, inability to use a regional technique, and the possibility of syncope or asystole if IV access is emergently needed.
Management reports include the use of an inhalational induction using sevoflurane for cesarean section, forceful placement of an IV, or oral/nasal sedative agents.
NP can become a barrier to medical care for the obstetric patient and should be addressed early in the pregnancy so that the patient may be evaluated by mental health for possible treatment with cognitive behavior therapy and by anesthesiology for discussion of the risks of avoiding needles during the peripartum period.
The therapeutic alliance established prior to induction likely contributed to the patient’s willingness to allow IV placement prior to administration of a sedative or inhalation agent in the operating room.
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