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Spinal anaesthesia and dysfibrinogenaemia.

D J Meldrum1, G Evans, P Popham

  • 1Department of Haematology, Addenbrooke's Hospital, Cambridge, UK.

International Journal of Obstetric Anesthesia
|August 24, 2004
PubMed
Summary

This case study highlights a triplet pregnancy managed with spinal anesthesia despite undiagnosed dysfibrinogenemia. The patient experienced postpartum hemorrhage but recovered without neurological complications, challenging contraindications for central neural blockade.

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Area of Science:

  • Obstetrics and Gynecology
  • Anesthesiology
  • Hematology

Background:

  • Triplet pregnancies increase obstetric risks, including postpartum hemorrhage.
  • Dysfibrinogenemia is a rare inherited bleeding disorder affecting fibrinogen function.
  • Central neural blockade is often cautioned in patients with bleeding disorders due to potential complications.

Purpose of the Study:

  • To report a case of spinal anesthesia in a patient with undiagnosed dysfibrinogenemia during a triplet pregnancy.
  • To discuss the safety and outcomes of central neural blockade in patients with fibrinogen disorders.
  • To review the literature for similar cases and anesthetic considerations.

Main Methods:

  • Case report of a 34-year-old woman with a triplet pregnancy.

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  • Elective cesarean section performed under spinal anesthesia.
  • Management of massive postpartum hemorrhage.
  • Postoperative investigation and diagnosis of dysfibrinogenemia.

    • Main Results:

    • The patient underwent cesarean section under spinal anesthesia without immediate complications.
    • Massive postpartum hemorrhage occurred, leading to the diagnosis of dysfibrinogenemia.
    • No neurological sequelae were observed following spinal anesthesia.
    • Family members were also identified with dysfibrinogenemia.

    Conclusions:

    • Central neural blockade may be feasible in selected patients with dysfibrinogenemia, even in high-risk obstetric scenarios.
    • Careful patient selection and multidisciplinary management are crucial when considering neuraxial anesthesia in patients with bleeding diatheses.
    • This case suggests that contraindications for central neural blockade in dysfibrinogenemia may warrant re-evaluation.