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

J Clin Anesth. 2014 Dec;26(8):623-7. doi: 10.1016/j.jclinane.2014.04.013. Epub 2014 Oct 18.

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.

Keywords: Cholestasis; Coagulopathy; Pregnancy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Academic Medical Centers
  • Adult
  • Analgesia, Obstetrical / methods*
  • Blood Coagulation Disorders / epidemiology*
  • Cesarean Section / adverse effects
  • Cholestasis, Intrahepatic / physiopathology*
  • Cohort Studies
  • Delivery, Obstetric / adverse effects
  • Delivery, Obstetric / methods
  • Female
  • Humans
  • Incidence
  • Partial Thromboplastin Time
  • Postpartum Hemorrhage / epidemiology*
  • Pregnancy
  • Pregnancy Complications / physiopathology*
  • Retrospective Studies

Supplementary concepts

  • Intrahepatic Cholestasis of Pregnancy