קלקסן ואפידורל / לידה

ראו הציטוט הבא 8. Anticoagulant therapy during labour and delivery, including the use of epidurals The woman should be advised that once she is established in labour or thinks that she is in labour, she should not inject any further heparin. She should be reassessed on admission to hospital and further doses should be prescribed by medical staff. The dose of heparin should be reduced to its thromboprophylactic dose on the day prior to induction of labour and continued in this dose during labour (for unfractionated heparin, this means a dose of 5000 iu given 12 hourly. For LMWH preparations, a once-daily regimen should be adopted using the following doses: enoxaparin 40 mg, tinzaparin 50 iu/kg, dalteparin 5000 iu).7,39,40 The treatment dose (twice daily administration) should be recommenced following delivery. Epidural anaesthesia can be sited only after discussion with a senior anaesthetist, in keeping with local anaesthetic protocols. Furthermore, it is important to discuss the implication of treatment with heparin or LMWH for epidural or spinal anaesthesia with the women prior to labour or caesarean section. In summary, to minimise or avoid the risk of epidural haematoma, regional techniques should not be used until at least 12 hours after the previous prophylactic dose of LMWH. When a woman presents while on a therapeutic regimen of LMWH (i.e. a twice-daily regimen), regional techniques should not be employed for at least 24 hours after the last dose of LMWH.41 LMWH should not be given for at least four hours after the epidural catheter has been removed and the cannula should not be removed within 10-12 hours of the most recent injection.42,43 For delivery by elective caesarean section, the woman should receive a thromboprophylactic dose of LMWH on the day prior to delivery and, on the day of delivery, the morning dose should be omitted and the operation performed that morning. The thromboprophylactic dose of LMWH should be given by three hours post-operatively (over four hours after removal of the epidural catheter, if appropriate) and the treatment dose recommenced that evening. There is an increased risk of wound haematoma following caesarean section with both unfractionated heparin and LMWH of around 2%. הציטוט לקוח מהמאמר הבא: http://www.rcog.org.uk/guidelines.asp?PageID=106&GuidelineID=20

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