TEALE FENNING

drhatta · Joined: 20 Feb 2007 Posts: 43 Location: Malaysia

A 25 year old woman with a previous DVT is a carrier of the factor V Leiden mutation and has been treated with a prophylactic dose of low molecular weight heparin during pregnancy. She presents in spontaneous labour at 36 weeks gestation and requests epidural analgesia. Her last dose of heparin was 14h earlier:

A Administer regional analgesia if APTT is normal
B Administer regional analgesia if APTT and PT are normal
C Administer protamine sulphate then regional analgesia
D Advice that regional analgesia is contra-indicated
E Administer regional analgesia
F Administer prophylactic dose of heparin
G Remove epidural catheter
H Check APTT then remove epidural catheter if result is normal
I Advise against removal of epidural catheter
J Check anti-Xa levels then administer regional analgesia if normal
K Wait for 12h then administer heparin

Nick Raine-Fenning · Posted: Tue May 26, 2009 5:51 pm Post subject:

L ask the anaesthetist Razz

drhatta · Joined: 20 Feb 2007 Posts: 43 Location: Malaysia

good one

Nick Raine-Fenning · Posted: Sat May 30, 2009 8:27 am Post subject:

Where is eveyone?? You are posting some good and topical questions - shame no one is around to discuss them and get some banter going! Sad

salihabduallah · Century Club Joined: 04 Sep 2007 Posts: 185

I think such lady should receivetherapeutic dose. If she is on rophy. dose, i think i will select E as R.A. can be given after 12 hours from last dose of Proph. LMWH.

pls correct for me if I'm wrong.

Thanks.

asma · Joined: 25 May 2007 Posts: 20

yes i will also go for E because regional analgesia can be give after 12 hours of prophylactic dose

chinnu · Joined: 06 Jan 2009 Posts: 105 Location: KSA

I would say regional analgesia is contraindicated. The period of 12 hrs applies for prophyllactic dose of unfractionated heparin. LMWH has a longer duration of action so 14 hrs is not enough. Pls correct me if I am wrong.