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Re: Labor epidrual and ChorioFrom: Ronald E. Ainsworth (ainsron@msn.com)Sun Oct 31 21:53:10 1999
>their concern was a potential coagulopathy. frequently, bleeding times and >platelet counts were required to consider placement for an epidural. doesn't >make any clinical sense but that was their rule, not mine. I agree that the exclusion of CLE for a patient with chorioamnionitis on antibiotics does not make any sense. Sol Shnider, in Anesthesia for Obstetrics, 3rd ed, makes these points: " 1. In the presence of signs of systemic infection from chorioamnionitis ensure that antibiotic coverage is started before proceeding to epidural blockade. 2. Perform the block as meticulously and gently as possible. 3. If in doubt about the feasibility of an atraumatic puncture, abandon regional anesthesia and proceed to systemic analgesia for labor and to general anesthesia for cesarean section. 4. If a block is performed, it is wise to instruct the patient and her partner in the premonitory symptoms and signs of epidural abscess, so that valuable time can be saved and permanent sequelae ovided by instituting the appropriate investigation and treatment as soon as possible after early warning signs develop." The other clinical scenario of excluding patients with severe toxemia is also contrary to modern ob anesthesia practice, in fact in most texts it is the anesthesia of choice, unless if they have HELLP syndrome or any other clinical condition with a platelet count of below 50,000 or signs of DIC which falls under the absolute contraindications for regional anesthesia in every text and paper I've read. The last thing needed is an epidural hematoma following a difficult to manage labor.
-- Ronald E. Ainsworth, MD, FACOG
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