Coagulation studies in the preeclamptic parturient: a survey

Abstract

Study objective: To delineate current practice with regard to how coagulation status is evaluated before induction of regional anesthesia in the preeclamptic parturient, with the goal of defining appropriate testing.

Design: A confidential survey was mailed to the chairmen of all 113 anesthesiology residency training programs in the United States listed in the American Medical Association's American Medical Graduation Education guide, to be passed on to the director of obstetric anesthesia.

Setting: Academic institutions providing obstetric anesthesia services in the United States.

Interventions: Following the original study, there was no additional follow-up or intervention.

Measurements and main results: The 21-question survey explored institutional characteristics such as the number of deliveries, the use of regional anesthesia, and the laboratory tests required prior to placement of a regional anesthetic in the mildly or severely preeclamptic parturient under two degrees of operative urgency. In the 74 programs entered into the analysis, we found that regional anesthesia was used in the majority of cesarean sections and more than half of the vaginal deliveries. In an urgent situation, most of the programs required no test of coagulation status in the mild preeclamptic parturient and only a platelet count in the severe preeclamptic parturient.

Conclusions: In the majority of academic programs in the United States, we found that the evaluation of coagulation status in the preeclamptic parturient was based primarily on a platelet count. A review of the literature supports this pattern of testing.