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Re: Labor epidrual and ChorioFrom: William Camann (wcamann@partners.org)Sun Oct 31 14:05:26 1999
At Sun, 31 Oct 1999, Mark G. Newman wrote: > >Dear Listpersons: > >Please render some opinions about a situation that arose recently at one of >the hospitals I practice in... >A young woman was transferred to my institution with preterm PROM at 33+5 >weeks. On arrival, she was contracting, had a temperature of 100.7, and had >mild uterine tenderness. The diagnosis of chorioamnionitis was made, and >broad spectrum antibiotics and pitocin was begun. At cervical exam of >3/100/-1, the patient requested epidural anesthesia for labor pain. The >anesthesiologist refused, stating that the patient had chorio, and thus >epidural was contraindicated. A second, backup anesthesiologist also >refused for the same reason. > >Am I missing something? >The literature says nothing about chorio as a contraindication to epidural, >only local infection at the site of puncture. > >Any others with experience or opinions? >************************************ I am an obstetric anesthesiologist. We routinely place epidurals in patients with chorioamnionitis, and have done so for many years. In fact, most (I can not speak for all) anesthesiologists will do so without hesitation, ESPECIALLY if the patient is treated with antibiotics. There is essentially no literature saying this is an unsafe practice, and what little literature there is supports the safe use of regional anesthesia. For references, see: 1. Bader, et al. Regional anesthesia in women with chorioamnionitis. Regional anesthesia 1992;17:84-86 2. Goodman, et al. Safety of spinal and epidural anesthesia in parturients with chorioamnionitis. Regional anesthesia 1996;21:436-41 Hope this helps.
Bill Camann
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