Influence of anticoagulant therapy during pregnancy on the peripartum and anesthesia delivery terms

Objectives. - The objective of the study was to evaluate the influence of anticoagulation on intrapartum anesthesia and delivery modalities. Methods. - This ancillary study is concerned with anticoagulated patients included in the study STRATHEGE, in the Saint-Etienne and Lyon University Hospital from 2007 to 2012, which are compared to a control population. The primary endpoint is to evaluate the type of anesthesia received by women in labor, according to the center at the time of delivery compared to no treatment. The secondary endpoints are comparing the input mode to work, mode of delivery, stop management arrangements of these treatments, the rate of thromboembolic and hemorrhagic complications. Results. - Two hundred and three cases were included and 812 controls, matched on age, body mass index and parity. 61.6% of the cases had an epidural during childbirth against 87% of controls (p <0.05), spinal rates (22.5% versus 1.85%) and general anesthesia (5.4% versus 0.7%) were higher in the case group. The delivery rate vaginally was 90% in controls, against 65% of cases. The postpartum hemorrhage rate was similar in both groups (p > 0.05). A relay of the low molecular weight heparin was performed in 63% of the cases in Lyon, but the types of anesthesia received according to the centers were similar. Conclusion. - Anticoagulant therapy at the time of delivery, does not limit access to effective analgesia, but with an increased rate of spinal anesthesia and general anesthesia at the expense of epidural anesthesia. The management of a parturient anticoagulant is complex and still exists today, great care disparities in the various maternity hospitals. (C) 2015 Elsevier Masson SAS. All rights reserved.