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When to Remove an Epidural Catheter in a Parturient with Disseminated Intravascular Coagulation
  1. Juraj Sprung, M.D., PH.D.*,
  2. Eugene Y. Cheng, M.D.** and
  3. Smita Patel, M.D.
  1. From the Department of Anesthesiology, Medical College of Wisconsin, Milwaukee.
  2. *Resident in Anesthesiology.
  3. **Associate Professor of Anesthesiology and Medicine.
  4. Assistant Professor of Anesthesiology.
  1. Address correspondence to Eugene Y. Cheng, M.D., Associate Professor of Anesthesiology and Medicine, Department of Anesthesiology, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI 53226.

Abstract

Background and Objectives. Pain from labor and delivery is often attenuated with epidural anesthesia. A complication of indwelling epidural catheters is intraspinal hematoma. The development of a bleeding diathesis can worsen complications markedly.

Conclusions. Frequent assessment of neurologic status is important until the underlying cause of the coagulopathy can be treated and the bleeding resolves. If there is no indication of intraspinal bleeding, we recommend removing the catheter because of potential catheter migration. If bleeding is occurring around the catheter insertion site and possibly in the epidural or subarachnoid space, the catheter may be left in place to tamponade the insertion site. In cases of intraspinal hematoma, which can cause neurologic deficits, immediate decompression surgery is needed.

  • Labor and delivery
  • analgesia
  • analgesia techniques
  • epidural complications
  • intraspinal hematoma.

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Footnotes

  • The authors thank Nordeana Nimphius for her assistance in manuscript preparation.

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