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[Evaluation of hemostasis before obstetrical epidural anesthesia: a survey in 435 French obstetric departments]
1Département d'anesthésie-réanimation, hôpital Saint-Vincent-de-Paul, Paris, France.
Objectives:
To specify by which means French anaesthesiologists evaluate the haemostasis profile of pregnant women before epidural analgesia.
Study Design:
Nationwide retrospective survey.
Material:
Questionnaire sent of 847 French obstetrical units.
Methods:
Comparison of categorical qualitative parameters using a chi 2 test.
Results:
Answers from 435 centres, including 1,834 anaesthesiologists, performing 227 x 10(3) epidurals for 411 x 10(3) deliveries/year were obtained. A preanaesthetic clinical assessment was performed systematically in two out of three units, and blood samples for PT, aPTT and platelet count were taken in more than 90% of the centres. These laboratory examinations were often made during the 9th month of pregnancy (74%). For more than one-third of the anaesthesiologists, biological data are not essential before epidural puncture. In addition, the lower limits considered as being safe before epidural puncture were highly variable between the teams.
Conclusions:
Coagulation laboratory tests are almost always ordered before epidural obstetrical analgesia in France. The rationale to perform them is not always related to pregnancy induced haemostatic changes. Therefore, this problem should be clarified by a consensus conference for both practical and economical reasons.