Coagulation testing before epidural analgesia at delivery: Cost analysis

  • Franca Franchi
    Affiliations
    A. Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Medicine and Medical Specialties, IRCCS Ca’ Granda Foundation Maggiore Hospital Policlinico and University of Milan, Milan, Italy
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  • Buthaina Ibrahim
    Affiliations
    A. Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Medicine and Medical Specialties, IRCCS Ca’ Granda Foundation Maggiore Hospital Policlinico and University of Milan, Milan, Italy
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  • Federica Rossi
    Affiliations
    A. Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Medicine and Medical Specialties, IRCCS Ca’ Granda Foundation Maggiore Hospital Policlinico and University of Milan, Milan, Italy
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  • Maria Luisa Maspero
    Affiliations
    A. Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Medicine and Medical Specialties, IRCCS Ca’ Granda Foundation Maggiore Hospital Policlinico and University of Milan, Milan, Italy
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  • Oronzo Morabito
    Affiliations
    Central Laboratory of Chemical Analysis and Microbiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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  • Daniela Asti
    Affiliations
    Central Laboratory of Chemical Analysis and Microbiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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  • Paolo Bucciarelli
    Affiliations
    A. Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Medicine and Medical Specialties, IRCCS Ca’ Granda Foundation Maggiore Hospital Policlinico and University of Milan, Milan, Italy
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  • Eugenia Biguzzi
    Correspondence
    Corresponding author at: A. Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Medicine and Medical Specialties, IRCCS Ca’ Granda Foundation Maggiore Hospital Policlinico and University of Milan, via Pace 9, Milan. Tel.: +39 0255036540.
    Affiliations
    A. Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Medicine and Medical Specialties, IRCCS Ca’ Granda Foundation Maggiore Hospital Policlinico and University of Milan, Milan, Italy
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      Abstract

      Backgound

      The usefulness of coagulation tests performed before epidural analgesia for surgery or to alleviate labour pain is controversial. The aims of this study were: 1) to evaluate the prevalence of abnormal tests in a large cohort of healthy pregnant women and their association with epidural hematoma; 2) to assess the approach of the anesthesiologists to women with abnormal tests; 3) to evaluate the cost of performing coagulation tests before epidural analgesia in all healthy pregnant women.

      Methods

      Data regarding epidural analgesia, epidural hematoma, PT, APTT, fibrinogen and platelet count were extracted from medical charts.

      Results

      There was no case of epidural hematoma in 2546 pregnant women undergoing epidural analgesia. PT and APTT results were obtained in 2871 women; fibrinogen in 4063 women; platelet count in 5090 women. Three of them (0.1%) had a prolonged PT, 4 (0.14%) had a prolonged APTT, 27 (0.53%) had platelets ≤100×109/L and 37 (0.91%) had plasma fibrinogen levels <3 g/L. No further tests were requested by the anesthesiologists in these women. Only women with platelets <80×109/L were denied epidural analgesia. Based on the data from the literature on the frequencies of epidural hematoma after epidural analgesia, a total cost ranging from 4.5 to 40 million Euros to perform coagulation tests would be necessary to avoid one case of epidural hematoma.

      Discussion

      Unselected coagulation tests before epidural analgesia are not recommended, because epidural hematoma is extremely rare in healthy pregnant women and the cost of screening is not justified.
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