Spinal anaesthesia, a special consideration in antiphospholipid antibody syndrome in pregnancy: A case series

Eesha Banerjee, S. Samanta, Soumya Samal
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Abstract

Antiphospholipid syndrome (APLA) is an acquired autoimmune disorder, clinically characterised by the development of thrombosis and obstetric morbidities comprising recurrent miscarriages, fetal deaths and premature births resulting from placental insufficiency such as intrauterine growth restriction and pre-eclampsia. It is the most common acquired hypercoagulable state where the focus of management is anticoagulation for the prevention of thrombosis.We report three cases of primary APLA syndrome in parturients at term with history of multiple abortions, being managed with oral aspirin and low molecular weight heparin posted for elective caesarian section. All three parturients were given single shot atraumatic spinal anaesthesia achieving a level of sensory blockade up to T6 since their coagulation profile showed no abnormalities. Antiphospholipid-antibody syndrome requires a multidisciplinary approach during pregnancy where use of anticoagulants may lead to dilemma of their perioperative continuation. Discontinuation of anticoagulants is a double-edged sword requiring careful deliberation on the part of anaesthetist to reduce the risk of perioperative bleeding.
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脊髓麻醉是妊娠期抗磷脂抗体综合征的一个特殊考虑因素:一系列病例
抗磷脂综合征(APLA)是一种获得性自身免疫性疾病,临床特征为血栓形成和产科疾病,包括反复流产、胎儿死亡和胎盘功能不全导致的早产,如宫内生长受限和先兆子痫。它是最常见的获得性高凝状态,治疗的重点是抗凝以预防血栓形成。我们报告了三例有多次流产史的足月产妇的原发性APLA综合征,采用口服阿司匹林和低分子肝素进行选择性剖腹产治疗。所有三名产妇都接受了一次性无创伤脊髓麻醉,达到了T6的感觉阻断水平,因为她们的凝血特征没有显示异常。抗磷脂抗体综合征需要在妊娠期间采取多学科的方法,使用抗凝剂可能会导致围手术期继续使用的困境。抗凝血剂的停用是一把双刃剑,需要麻醉师仔细考虑,以降低围手术期出血的风险。
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发文量
37
审稿时长
29 weeks
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