Haemostasis and epidural anaesthesia in obstetrics

Epidural anaesthesia is the most effective method for obstetrical pain relief. The technique is safe in the absence of clotting disorders. Puncture-induced haematomas near the spinal cord are rare, but there is an increased risk if severe coagulopathy is present. No laboratory screening is necessary if physical examination and medical history are without pathological findings or contributory factors. Platelet count is a sufficient screening method for most coagulopathies in pregnancy. Occasionally, other specific coagulation analyses may be necessary. In cases of severe coagulopathies and bleeding disorders, early consultation between the obstetrician, anaesthetist and haematologist is mandatory in order to determine the safest approach and to achieve a maximum benefit for the parturient.