patient is given a trial of labor, and the obstetrician requests a consult for
labor analgesia. What are your concerns and how would you proceed?
The clinical presentation, painful vaginal
bleeding, is consistent with the diagnosis of a placental abruption. Before a
regional anesthetic is initiated, the patient’s intravascular volume, blood
count, and coagulation status require careful evaluation. Initial laboratory
evaluation should include a hemoglobin, hematocrit, platelet count, PT/PTT,
fibrinogen level, and fibrin split products to eval-uate the degree of
hemorrhage and to rule out the devel-opment of DIC. Volume repletion should be
with crystalloid, colloid, or packed red blood cells, as indicated.
If significant hemorrhage has not occurred and
there is no laboratory evidence of DIC, epidural analgesia may be instituted.