Conditions for the use of regional block in women with IBDs during labor and delivery36
| Multidisciplinary management involving hematologists, anesthetists, obstetricians, and the mother |
| Detailed counseling on the benefits and risks of regional block and its alternatives to help the mother make an informed decision |
| Careful assessment of coagulation status, including assessment of clotting factor during the third trimester, and bleeding phenotype, including personal and family bleeding history |
| Availability of therapeutic products and laboratory facilities to ensure adequate response to treatment |
| Plan of management made antenatally during the third trimester, clearly documented, and readily available to professionals attending the woman in labor |
| Normalization of coagulation defect by either a pregnancy-induced rise in coagulation factors or the use of appropriate prophylactic treatment prior to regional block procedures |
| Meticulous technical skills in the administration of regional block by an experienced anesthetist |
| Where an epidural catheter is placed, adequate hemostasis should be maintained prior to catheter removal, as the risk of bleeding is no less than with insertion |
| Awareness and surveillance for symptoms and signs of potential complications |
| Multidisciplinary management involving hematologists, anesthetists, obstetricians, and the mother |
| Detailed counseling on the benefits and risks of regional block and its alternatives to help the mother make an informed decision |
| Careful assessment of coagulation status, including assessment of clotting factor during the third trimester, and bleeding phenotype, including personal and family bleeding history |
| Availability of therapeutic products and laboratory facilities to ensure adequate response to treatment |
| Plan of management made antenatally during the third trimester, clearly documented, and readily available to professionals attending the woman in labor |
| Normalization of coagulation defect by either a pregnancy-induced rise in coagulation factors or the use of appropriate prophylactic treatment prior to regional block procedures |
| Meticulous technical skills in the administration of regional block by an experienced anesthetist |
| Where an epidural catheter is placed, adequate hemostasis should be maintained prior to catheter removal, as the risk of bleeding is no less than with insertion |
| Awareness and surveillance for symptoms and signs of potential complications |