Florence Feucht1,2, Pierre Richart3, Nathalie Trillot4, Louise Ghesquiere5, Charles Garabedian5, Damien Subtil5. 1. Woman-Mother-Newborn Unit, Lille University Hospital Center, Jeanne de Flandre Hospital, Lille University, 59000, Lille, France. florence.feucht@chu-reunion.fr. 2. Hôpital Jeanne de Flandre, Université Lille Nord de France, 1 rue Eugène Avinée, 59037, Lille Cedex, France. florence.feucht@chu-reunion.fr. 3. Department of Anesthesiology and Resuscitation, Lille University Hospital Center, Lille University, 59000, Lille, France. 4. Lille University Hospital Center, Hematology and Transfusion Institute, Lille University, 59000, Lille, France. 5. Woman-Mother-Newborn Unit, Lille University Hospital Center, Jeanne de Flandre Hospital, Lille University, 59000, Lille, France.
Abstract
PURPOSE: When vaginal delivery is considered in women with low-molecular-weight heparin (LMWH) treatment, epidural analgesia is contraindicated for 12-24 h after the last injection. We evaluated the proportion of epidural analgesia depending on whether this is scheduled delivery (labor induction after stopping LMWH) or unscheduled delivery (stopping LMWH at labor onset). METHODS: Retrospective hospital study running from 2015 to 2017. Inclusion criteria for patients with LMWH treatment were: singleton pregnancy, gestational age ≥ 38 weeks of gestation and possible vaginal delivery. The primary endpoint was the epidural analgesia rate. Secondary endpoints included risks for caesarean section, deep vein thrombosis, and postpartum hemorrhage. RESULTS: Among 129 patients, 54 had scheduled delivery (41.9%). In practice, only 44 of them had labor induction (81.5%) and 54 of the 75 patients in the unscheduled delivery group had spontaneous delivery (72.0%). There was no significant difference in the rate of epidural analgesia between the "scheduled" and "unscheduled" groups (52/54 (96.3%) vs. 66/75 (88.0%) (p = 0.12)), and no difference in the secondary endpoints. CONCLUSION: High access rates to epidural analgesia are observed in both scheduled and unscheduled deliveries. Scheduled delivery does not appear to be a really advantageous strategy for women with LMWH prophylaxis.
PURPOSE: When vaginal delivery is considered in women with low-molecular-weight heparin (LMWH) treatment, epidural analgesia is contraindicated for 12-24 h after the last injection. We evaluated the proportion of epidural analgesia depending on whether this is scheduled delivery (labor induction after stopping LMWH) or unscheduled delivery (stopping LMWH at labor onset). METHODS: Retrospective hospital study running from 2015 to 2017. Inclusion criteria for patients with LMWH treatment were: singleton pregnancy, gestational age ≥ 38 weeks of gestation and possible vaginal delivery. The primary endpoint was the epidural analgesia rate. Secondary endpoints included risks for caesarean section, deep vein thrombosis, and postpartum hemorrhage. RESULTS: Among 129 patients, 54 had scheduled delivery (41.9%). In practice, only 44 of them had labor induction (81.5%) and 54 of the 75 patients in the unscheduled delivery group had spontaneous delivery (72.0%). There was no significant difference in the rate of epidural analgesia between the "scheduled" and "unscheduled" groups (52/54 (96.3%) vs. 66/75 (88.0%) (p = 0.12)), and no difference in the secondary endpoints. CONCLUSION: High access rates to epidural analgesia are observed in both scheduled and unscheduled deliveries. Scheduled delivery does not appear to be a really advantageous strategy for women with LMWH prophylaxis.
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