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pancytopenia. Obstet. Gynecol. 1977; 50: 732“4. marrow failure. Anesth. Analg. 1972; 51: 597.
64. Fleming, A. F. Hypoplastic anaemia in pregnancy. J. Obstet. Gynaecol. Br. 91. Wong, A. Y. C., Chan, R. S. N. & Irwin, M. G. Anesthetic management of
Commonw. 1968; 75: 138“41. cesarean delivery in a patient with hypoplastic anemia and severe pre-
65. Collins, D. J., Rosenthal, D. S., Goldstein, D. P. & Moloney, W. C. Aplastic eclampsia. Can. J. Anesth. 2004; 51: 923“7.
anemia in pregnancy. Obstet. Gynecol. 1972; 39: 884“6. 92. Hara, K., Saito, Y., Morimoto, N., Sakura, S. & Kosaka. Y. Anaesthetic
66. Cohen, E., Ilan, Y., Gillis, S., Dann, E. J. & Rachmilewitz, E. A. Recurrent management of caesarean section in a patient with myelodysplastic syn-
transient bone marrow hypoplasia associated with pregnancy. Acta drome. Can. J. Anaesth. 1998; 45: 157“63.
Haematol. 1993; 89: 32“4. 93. Stocche, R. M., Garcia, L. V. & Klamt, J. G. Labor analgesia in a patient with
67. Aggio, M. C. & Zunini, C. Reversible pure red-cell aplasia in pregnancy. paroxysmal nocturnal hemoglobinuria with thrombocytopenia. Reg.
(Letter) N. Engl. J. Med. 1977; 297: 221“2. Anesth. Pain Med. 2001; 26: 79“82.
68. Leong, K. W., Teh, A., Bosco, J. J. & Lim, J. Successful pregnancy following 94. Kjaer, K., Comerford, M. & Gadalla, F. General anesethesia for cesarean
aplastic anemia. Post. Grad. Med. J. 1995; 71: 625“7. delivery in a patient with paroxysmal nocturnal hemoglobinuria and
69. Deka, D., Malhotra, N., Sinha, A. et al. Pregnancy associated aplastic thrombocytopenia. Anesth. Analg. 2004; 98: 1471“2.
anemia: maternal and fetal outcome. J. Obstet. Gynaecol. Res. 2003; 29: 95. Paech, M. J. & Pavy, T. J. G. Management of a parturient with paroxysmal
67“72. nocturnal hemoglobinuria. Int. J. Obstet. Anesth. 2004; 13: 188“91.
70. Choudhry, V. P., Gupta, S., Gupta, M., Kashyap, R. & Saxena, R. Pregnancy 96. Harrison, C. Pregnancy and its management in the Philadelphia negative
associated aplastic anemia “ a series of 10 cases with review of the literature. myeloproliferative diseases. Br. J. Haematol. 2005; 129: 293“306.
Hematology 2002; 7: 233“8. 97. Burrows, R. F. Platelet disorders in pregnancy. Curr. Opin. Obstet. Gynecol.
71. Knispel, J. W., Lynch, V. A. & Viele, B. D. Aplastic anemia in pregnancy: a 2001; 13: 115“19.
case report, review of the literature, and a re-evaluation of management. 98. Harrison, C. N. Essential thrombocythaemia: challenges and evidence-
Obstet. Gynecol. Surv. 1976; 31: 523“8. based management. Br. J. Haematol. 2005; 130: 153“65.
72. Aitchison, R. G. M., Marsh, J. C. W., Hows, J. M., Russell, N. H. & Gordon- 99. Vadher, B. D., Machin, S. J., Patterson, K. G., Sukhu, C. & Walker H. Life-
Smith, E. C. Pregnancy associated aplastic anaemia: a report of five cases threatening thrombotic and haemorrhagic problems associated with
and review of current management. Br. J. Haematol. 1989; 73: 541“5. silent myeloproliferative disorders. Br. J. Haematol. 1993; 85: 213“16.
73. Ang, H. Y. & Linn, Y. C. A case of aplastic anaemia in pregnancy. Aust. N.Z. J. 100. Schafer, A. I. Essential thrombocythemia. Prog. Hemost. Thromb. 1991; 10:
Obstet. Gynaecol. 1999; 39: 102“5. 69“96.

Chapter 17

101. Katz, L. E., Goyert, G. L., Bloom, R. E. et al. Essential thrombocytosis in 126. Hosoi, S., Adachi, T., Hara, T. et al. Pulmonary embolism after minor surgery
pregnancy: is pharmacologic therapy indicated? (letter) J. Mat. Fetal Med. in a patient with low-risk thrombocythemia. J. Anesth. 2004; 18: 146.
1994; 3: 193. 127. Ulrich, B. & Krelenbuhl, G. Complication after artery catheterization:
102. Bangerter, M., Guthner, C., Beneke, H. et al. Pregnancy in essential throm- digital gangrene in a patient with myeloproliferative disease with throm-
bocythaemia: treatment and outcome of 17 pregnancies. Eur. J. Haematol. bocytosis. (letter) Anesth. Analg. 2000; 91: 767“8.
2000; 65: 165“9. 128. Rehfeldt, K. H. & Sanders, M. S. Digital gangrene after radial artery cathe-
103. Randi, M. L., Barbone, E., Rossi, C. & Girolami, A. Essential thrombocythe- terization in a patient with thrombocytosis. Anesth. Analg. 2000; 90: 45“6.
mia and pregnancy: a report of six normal pregnancies in five untreated 129. Coleman, A. J. & Sliom, C. M. Polycythaemic hypoxaemia and general
patients. Obstet. Gynecol. 1994; 83: 915“17. anaesthesia. A case report. Br. J. Anaesth. 1966; 38: 653“5.
104. Spivak, J. L. Polycythemia vera: myths, mechanisms, and management. 130. Schmitt, H. J., Becke, K. & Neidhardt, B. Epidural anesthesia for cesarean
Blood 2002; 100: 4272“90. delivery in a patient with polycythemia rubra vera and preeclampsia.
105. Terek, M. C., Ozkinay, E., Zekioglu, O. et al. Acute leukemia in pregnancy Anesth. Analg. 2001; 92: 1535“7.
with ovarian metastasis: a case report and review of the literature. Int. 131. Spencer, J., Gadalla, F., Wagner, W. & Blake, J. Caesarean section in a
J. Gynecol. Cancer 2003; 13: 904“8. diabetic patient with a recent myocardial infarction. Can. J. Anaesth.
106. Caligiuri, M. A. & Mayer, R. J. Pregnancy and leukemia. Semin. Oncol. 1989; 1994; 41: 516“18.
16: 388“96. 132. Bucklin, B. A., Tinker, J. H. & Smith, C. V. Clinical dilemma: a patient with
107. Zuazu, J., Julia, A., Sierra, J. et al. Pregnancy outcome in hematologic postdural puncture headache and acute leukemia. Anesth. Analg. 1999; 88:
malignancies. Cancer 1991; 67: 703“9. 166“8.
108. Celo, J. S., Kim, H. C., Houlihan, C. et al. Acute promyelocytic leukemia in 133. Lipton, J. H., Derzko, C., Fyles, G., Meharchand, J. & Messner, H. A.
pregnancy: all-trans retinoic acid as a newer therapeutic option. Obstet. Pregnancy after BMT: three case reports. Bone Marrow Transplantation
Gynecol. 1994; 83: 808“11. 1993; 11: 415“18.
109. Doll, D. C., Ringenberg, Q. S. & Yarbro, J. W. Management of cancer during 134. Stein, R. A., Messino, M. J. & Hessel, E. A., 2nd. Anaesthetic implications for
pregnancy. Arch. Intern. Med. 1988; 148: 2058“64. bone marrow transplant recipients. Can. J. Anaesth. 1990; 37: 571“8.
110. Pejovic, T. & Schwartz, P. E. Leukemias. Clin. Obstet. Gynecol. 2002; 45: 135. Salooja, N., Szydio, R. M., Socie, G. et al. Pregnancy outcomes after peri-
866“78. pheral blood or bone marrow transplantation: a retrospective survey.
111. Mubarak, A. A. S., Kakil, I. R., Awidi, A. et al. Normal outcome of pregnancy Lancet 2001; 358: 271“6.
in chronic myeloid leukemia treated with interferon-a in 1st trimester: 136. Scott, D. B. & Hibberd, B. M. Serious non-fatal complications associated
report of 3 cases and review of the literature. Am. J. Hematol. 2002; 69: with extradural block in obstetric practice. Br. J. Anaesth. 1990; 64: 537“41.
115“18. 137. Crawford, J. S. Some maternal complications of epidural analgesia for
112. Taylor, U. B., Bardeguez, A. D., Iglesias, N. & Gascon, P. Idiopathic myelo- labour. Anaesthesia 1985; 40: 1219“25.
fibrosis in pregnancy: a case report and review of the literature. Am. 138. Loo, C. C., Dahlgren, G. & Irestedt, L. Neurological complications in obste-
J. Obstet. Gynecol. 1991; 167: 38“9. tric regional anaesthesia. Int. J. Obstet. Anesth. 2000; 9: 99“124.
113. Ward, F. T. & Weiss, R. B. Lymphoma and pregnancy. Semin. Oncol. 1989; 139. British Committee for Standards in Haematology General Haematology
16: 397“409. Task Force. Guidelines for the investigation and management of idio-
114. Gobbi, P. G., Attardo-Parinello, G., Danesino, M. et al. Hodgkin™s disease pathic thrombocytopenic purpura in adults, children and in pregnancy.
and pregnancy. Haematologica 1984; 69: 336“41. Br. J. Haematol. 2003; 120: 574“96.
115. Klezl, Z., Krbec, M., Gregora, E. & Stritesky, J. Rare presentation of non- 140. Louden, K. A., Broughton Pipkin, F., Heptinstall, S. et al. A longitudinal
Hodgkin lymphoma of the thoracolumbar spine in pregnancy with 7 study of platelet behaviour and thromboxane production in whole blood
years™ survival. Arc. Orthop. Trauma Surg. 2002; 122: 308“10. in normal pregnancy and the puerperium. Br. J. Obstet. Gynaecol. 1990; 97:
116. Dasan, J., Littleford, J., McRae, K., Farine, D. & Winton, T. Mediastinal 1108“14.
tumour in a pregnant patient presenting as acute cardiorespiratory com- 141. Harker, L. A. & Slichter, S. J. The bleeding time as a screening test
promise. Int. J. Obstet. Anesth. 2002; 11: 52“6. for evaluation of platelet function. N. Engl. J. Med. 1972; 287: 155“9.
117. Szokol, J. W., Alspach, D., Mehta, M. K., Parilla, B. V. & Liptay, M. J. 142. Burrows, R. F. & Kelton, J. G. Incidentally detected thrombocytopenia in
Intermittent airway obstruction and superior vena cava syndrome in a healthy mothers and their infants. N. Engl. J. Med. 1988; 319: 142“5.
patient with undiagnosed mediastinal mass after cesarean delivery. 143. Anteby, E. & Shalev, O. Clinical relevance of gestational thrombocytopenia
Anesth. Analg. 2003; 97: 883“4. of <100,000/ml. Am. J. Hematol. 1994; 47: 118“22.
118. Malee, M. P. Multiple myeloma in pregnancy: a case report. Obstet. 144. Rolbin, S. H., Abbot, D., Musclow, E. et al. Epidural anesthesia in pregnant
Gynecol. 1990; 75: 513“15. patients with low platelet counts. Obstet. Gynecol. 1988; 71: 918“20.
119. Caudle, M. R., Dodd, S. & Solomon, A. Multiple myeloma in pregnancy: a 145. Rasmus, K. T., Rottman, R. L., Kotelko, D. M. et al. Unrecognized thrombo-
case report. Obstet. Gynecol. 1990; 75: 516“18. cytopenia and regional anesthesia in parturients: a retrospective review.
120. Pajor, A., Kelemen, E., Mohos, Z., Hambach, J. & Varadi, G. Multiple Obstet. Gynecol. 1989; 73: 943“6.
myeloma in pregnancy. Int. J. Gynaecol. Obstet. 1991; 35: 341“2. 146. Burrows, R. F. & Kelton, J. G. Thrombocytopenia at delivery. A prospective
121. Maglione, A., Di Giorgio, G., Petruzelli, F. & Pia Longo, M. Multiple mye- survey of 6715 deliveries. Am. J. Obstet. Gynecol. 1990; 162: 731“4.
loma diagnosed during early pregnancy: a case report. Eur. J. Obstet. 147. Ballem, P. J., Segal, G. M., Stratton, J. R. et al. Mechanisms of thrombocy-
Gynecol. Reprod. Biol. 2003; 111: 214“15. topenia in chronic autoimmune thrombocytopenic purpura. Evidence of
122. Forthman, C. L., Ponce, B. A. & Mankin, H. J. Multiple myeloma with a both impaired platelet production and increased platelet clearance.
pathologic fracture during pregnancy. J. Bone Joint Surg. 2004; 86-A: J. Clin. Invest. 1987; 80: 33“40.
1284“8. 148. Cines, D. B. & Blanchette, B. S. Immune thrombocytopenic purpura. N.
123. Cheung, V. Y. T., Bocking, A. D., Hollomby, D., Gagnon, R. & Walton, Engl. J. Med. 2002; 346: 995“1008.
J. Waldenstrom hypergammaglobulinemic purpura and pregnancy. 149. Paidas, M. J., Haut, M. J. & Lockwood, C. J. Platelet disorders in pregnancy:
Obstet. Gynecol. 1993; 82: 685“7. implications for mother and fetus. Mt. Sinai J. Med. 1994; 61: 389“403.
124. Lowenwirt, I., Dadic, P. & Krishnamurthy, V. Essential thrombocythemia 150. Cines, D. B., Dusak, B., Tomaski, A., Mennuti, M. & Schreiber, A. D.
and epidural analgesia in the parturient: does thromboelastography help? Immune thrombocytopenic purpura and pregnancy. N. Engl. J. Med.
Reg. Anesth. 1996; 21: 525“8. 1982; 306: 826“31.
125. Garci-Ferreira, J., Hernandez-Palazon, J., Garcia-Candel, A. & Verdu- 151. Burrows, R. F. & Kelton, J. G. Low fetal risks in pregnancies associated with
Martinez, T. Subarachnoid block in a patient with essential thrombocyto- idiopathic thrombocytopenic purpura. Am. J. Obstet. Gynecol. 1990; 163:
penia. (letter) Anesth. Analg. 2005; 101: 800. 1147“50.

5 Other disorders

152. Cook, R. L., Miller, R. C., Katz, V. L. & Cefalo, R. C. Immune thrombocyto- 177. Ito, K., Yoshida, H., Hatoyama, H. et al. Antibody removal therapy used
penic purpura in pregnancy: a reappraisal of management. Obstet. successfully at delivery of a pregnant patient with Glanzmann™s throm-
Gynecol. 1991; 78: 578“83. basthenia and multiple anti-platelet antibodies. Vox Sang. 1991; 61: 40“6.
153. Samuels, P., Bussel, J. B., Braitman, L. E. et al. Estimation of the risk of 178. Poon, M-C, d™Oiron, R., Hann, I. et al. Use of recombinant Factor VIIa
thrombocytopenia in the offspring of pregnant women with presumed (NovoSeven’) in patients with Glanzmann thrombasthenia. Semin.
immune thrombocytopenic purpura. N. Engl. J. Med. 1990; 323: 229“35. Hematol. 2001; 38: 21“5.
154. Drachman, J. G. Inherited thrombocytopenia: when a low platelet count 179. Kale, A., Bayhan, G., Yalinkaya, A. & Yayla, M. The use of recombinant
does not mean ITP. Blood 2004; 103: 290“8. factor VIIa in a primigravida with Glanzmann™s thrombasthenia during
155. Rocca, B., Bellacosa, A., De Cristofaro, R. et al. Wiskott-Aldrich syndrome: delivery. J. Perinat. Med. 2004; 32: 456“8.
report of an autosomal dominant variant. Blood 1996; 87: 4538“43. 180. Monte, S. & Lyons, G. Peripartum management of patient with
156. Parolini, O., Ressmann, G., Haas, O. A. et al. X-linked Wiskott-Aldrich Glanzmann™s thrombasthenia using Thrombelastograph’. Br. J. Anaesth.
syndrome in a girl. New Engl. J. Med. 1998; 338: 291“5. 2002; 88: 734“8.
157. Mandelbrot, L., Schlienger, I., Bongain, A. et al. Thrombocytopenia 181. Thouli, E., Hay, C. R. M., O™Gorman, P. & Makris, M. Acquired
in pregnant women infected with human immunodeficiency virus: mater- Glanzmann™s thrombasthenia without thrombocytopenia: a severe
nal and neonatal outcome. Am. J. Obstet. Gynecol. 1994; 171: 252“7. acquired autoimmune bleeding disorder. Br. J. Haematol. 2004: 127:
158. Kam, P. C. A., Thompson, S. A. & Liew, A. C. S. Thrombocytopenia in the 209“13.
parturient. Anaesthesia 2004; 59: 255“64. 182. Rao, A. K. & Holmsen, H. Congenital disorders of platelet function. Sem.
159. Horlocker, T. T., Wedel, D. J., Benzon, H. et al. Regional anesthesia in the Hematol. 1986; 23: 102“18.
anticoagulated patient: defining the risks (the second ASRA Consensus 183. Wax, J. R., Rosengren, S., Spector, E., Gainey, A. J. & Ingardia, C. J. DNA
Conference on Neuraxial Anesthesia and Anticoagulation). Reg. Anesth. diagnosis and management of Hermansky-Pudlak syndrome in preg-
Pain Med. 2003; 28: 172“97. nancy. Am. J. Perinatol. 2001; 18: 159“61.
160. Peng. T. C., Kickler, T. S., Bell, W. R. & Haller, E. Obstetric complications in 184. Laskey, A. L. & Tobias, J. D. Anesthetic implications of the grey platelet
a patient with Bernard-Soulier syndrome. Am. J. Obstet. Gynecol. 1991; syndrome. Can. J. Anesth. 2000; 47: 1224“9.
165: 425“6. 185. Edozien, L. C. & Mayers, F. N. Platelet storage pool deficiency in preg-
161. Saade, G., Homsi, R. & Seoud, M. Bernard-Soulier syndrome in pregnancy: nancy. Br. J. Clin. Pract. 1995; 49: 220.
a report of four pregnancies in one patient, and review of the literature. 186. Thurlow, J. A. & Waterhouse, P. Patient-controlled analgesia in labour
Eur. J. Obstet. Gynecol. Reprod. Biol. 1991; 40: 149“52. using remifentanil in two parturients with platelet abnormalities. Br. J.
162. Kriplani, A., Malhotra Singh, B., Sowbernika, R. & Prakash Choudhry, V. Anaesth. 2000; 84: 411“13.
Successful pregnancy outcome in Bernard-Soulier syndrome. J. Obstet. 187. Weiner, C. P. Thrombotic microangiopathy in pregnancy and the postpar-
Gynaecol. Res. 2005; 31: 52“6. tum period. Sem. Hematol. 1987; 24: 119“29.
163. Fujimori, K., Ohto, H., Honda, S. & Sato, A. Antepartum diagnosis of fetal 188. Weinstein, L. Preeclampsia/eclampsia with hemolysis, elevated liver
intracranial hemorrhage due to maternal Bernard-Soulier syndrome. enzymes, and thrombocytopenia. Obstet. Gynecol. 1985; 66: 657“60.
Obstet. Gynecol. 1999; 94: 817“19. 189. Sibai, B. M., Taslimi, M. M., El-Nazer, A. et al. Maternal-perinatal outcome
164. Seri, M., Pecci, A., Di Bari, F. et al. MYH9-related disease. May-Hegglin associated with the syndrome of hemolysis, elevated liver enzymes, and
anomaly, Sebastian syndrome, Fechtner syndrome, and Epstein syn- low platelets in severe preeclampsia-eclampsia. Am. J. Obstet. Gynecol.
drome are not distinct entities but represent a variable expression of a 1986; 155: 501“9.
single illness. Medicine 2003; 82: 203“15. 190. Sibai, B. M., Ramadan, M. K., Usta, I. et al. Maternal morbidity and mor-
165. Toren, A., Rozenfeld-Granot, G., Heath, K. E. et al. MYH9 spectrum of tality in 442 pregnancies with hemolysis, elevated liver enzymes, and low
autosomal-dominant giant platelet syndromes: unexpected association platelets (HELLP syndrome). Am. J. Obstet. Gynecol. 1993; 169: 1000“6.
with fibulin-1 variant-D inactivation. Am. J. Hematol. 2003; 74: 254“62. 191. Sibai, B. M., Ramadan, M. K., Chari, R. S. & Friedman, S. A. Pregnancies
166. Fukada, Y., Yasumizu, T., Sumino, E. & Hoshi, K. A pregnancy complicated complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and
with Fechtner syndrome: a case report. J. Exp. Med. 2000; 191: 183“6. low platelets ): subsequent pregnancy outcome and long-term prognosis.
167. Chabane, H., Gallais, Y., Pathier, D., Tchernia, G. & Gaussem, P. Delivery Am. J. Obstet. Gynecol. 1995; 172: 125“9.
management in a woman with thrombocytopenia of the May-Hegglin 192. Martin, J. N., Blake, P. G., Perry, K. G. et al. The natural history of HELLP
anomaly type. Eur. J. Obstet. Gynecol. Reprod. Biol. 2001; 99: 124“5. syndrome: patterns of disease progression and regression. Am. J. Obstet.
168. Nelson, L. H., Dewan, D. M. & Mandell, G. L. Obstetric and anesthetic Gynecol. 1991; 164: 1500“13.
considerations in the May-Hegglin anomaly. A case report. J. Reprod. 193. Martin, J. N., Blake, P. G., Lowry, S. L. et al. Pregnancy complicated by
Med. 1993; 38: 311“13. preeclampsia-eclampsia with the syndrome of hemolysis, elevated liver
169. Kotelko, D. M. Anaesthesia for caesarean delivery in a patient with May- enzymes, and low platelet count: how rapid is postpartum recovery?
Hegglin anomaly. Can. J. Anaesth. 1989; 36: 328“30. Obstet. Gynecol. 1990; 76: 737“41.
170. Duff, P. & Jackson, M. T. Pregnancy complicated by rhesus sensitization 194. Roberts, W. E., Perry, K. G., Woods, J. B. et al. The intrapartum platelet
and the May-Hegglin anomaly. Obstet. Gynecol. 1985; 65: 7S-10S. count in patients with HELLP (hemolysis, elevated liver enzymes, and
171. Siddiqui, T., Lammert, N., Danier, P. & Luke, M. Immune thrombocyto- low platelets) syndrome: is it predictive of later hemorrhagic complica-
penia and May-Hegglin anomaly during pregnancy. J. Florida M. A. 1991; tions? Am. J. Obstet. Gynecol. 1994; 171: 799“804.
78: 88“91. 195. Rose, C. H., Thigpen, B. D., Bofill, J. A. et al. Obstetric implications of
172. Chatwani, A., Bruder, N., Shapiro, T. & Reece, E. A. May-Hegglin anomaly: antepartum corticosteroid therapy for HELLP syndrome. Obstet. Gynecol.
a rare case of maternal thrombocytopenia in pregnancy. Am. J. Obstet. 2005; 104: 1011“14.
Gynecol. 1992; 166: 143“4. 196. Ramanathan, J., Sibai, B. M., Vu, T. & Chauhan, D. Correlation between
173. Takashima, T., Maeda, H., Koyanagi, T., Nishimura, J. & Nakano, H. bleeding times and platelet counts in women with preeclampsia under-
Prenatal diagnosis and obstetrical management of May-Hegglin anomaly: going cesarean section. Anesthesiology 1989; 71: 188“91.
a case report. Fetal Diagn. Ther. 1992; 7: 186“9. 197. Schindler, M., Gatt, S., Isert, P., Morgans, D. & Cheung, A.
174. Gunay-Aygun, M., Huizing, M. & Gahl, W. A. Molecular defects that affect Thrombocytopenia and platelet functional defects in pre-eclampsia:
platelet dense granules. Semin. Thromb. Hemost. 2004; 30: 537“47. implications for regional anaesthesia. Anaesth. Intensive Care 1990; 18:
175. Price, F. V., Legro, R. S., Watt-Morse, M. & Kaplan, S. S. Chediak-Higashi 169“74.
syndrome in pregnancy. Obstet. Gynecol. 1992; 79: 804“6. 198. Whitta, R. K. S., Cox, D. J. A. & Mallett. S. V. Thromboelastography reveals
176. Sherer, D. M. & Lerner, R. Glanzmann™s thrombasthenia in pregnancy: a two causes of haemorrhage in HELLP syndrome. Br. J. Anaesth. 1995; 74:
case and review of the literature. Am. J. Perinatol. 1999; 16: 297“301. 464“8.

Chapter 17

199. Ramanathan, J., Khalil, M., Sibai, B. M. & Chauhan, D. Anesthetic manage- 223. Koizumi, M., Hagino, D., Fukuyama, C. et al. Sch¨ nlein-Henoch purpura
ment of the syndrome of hemolysis, elevated liver enzymes, and low during pregnancy: case report and review of the literature. J. Obstet.
platelet count (HELLP) in severe preeclampsia. A retrospective study. Gynaecol. Res. 2004; 30: 37“41.
Reg. Anesth. 1988; 13: 20“4. 224. Cummins, D. L., Mimouni, D., Rencic, A., Douba, D. J. & Nousari, C. H.
200. Crosby, E. T. Obstetrical anaesthesia for patients with the syndrome of Henoch-Sch¨ nlein purpura in pregnancy. Br. J. Dermatol. 2003; 149:
haemolysis, elevated liver enzymes and low platelets. Can. J. Anaesth. 128“5.
1991; 38: 227“33. 225. Douglas, M. J., Gunka, V. B. & Von Dadelszen, P. Anesthesia for the par-
201. Elliott, M. D. & Nichols, W. L. Thrombotic thrombocytopenic purpura and turient with pseudoxanthoma elasticum. Int. J. Obstet. Anesth. 2002; 12:
hemolytic uremic syndrome. Mayo Clin. Proc. 2001; 76: 1154“62. 45“7.
202. George, J. N. The association of pregnancy with thrombotic thrombocytopenic 226. Youngs, P. J., Sice, P. & Harvey, P. Labour analgesia and pseudoxanthoma
purpura-hemolytic uremic syndrome. Curr. Opin. Hematol. 2003; 10: 339“44. elasticum (PXE). Int. J. Obstet. Anesth. 2003; 12: 48“50.
203. McMinn, J. R. & George, J. N. Evaluation of women with clinically sus- 227. Levitt, M. W. D. & Collison, J. M. Difficult endotracheal intubation in a
pected thrombotic thrombocytopenic purpura-hemolytic uremic syn- patient with pseudoxanthoma elasticum. Anaesth. Intensive Care 1982;
drome. J. Clin. Apheresis 2001; 16: 202“9. 10: 62“4.
204. Hayward, C. P., Sutton, D. M., Carter, W. H., Jr. et al. Treatment outcomes 228. Peyvandi, F. & Mannuci, P. M. Rare coagulation disorders. Thromb.
in patients with adult thrombotic thrombocytopenic purpura-hemolytic Haemost. 1999; 82: 1207“14.
uremic syndrome. Arch. Intern. Med. 1994; 154: 982“7. 229. Kadir, R. A. Women and inherited bleeding disorders: pregnancy and
205. Vesely, S. K., George, J. N., Lammie, B. et al. ADAMTS13 activity in throm- delivery. Semin. Hematol. 1999; 36: 28“35.
botic thrombocytopenic pupura-hemolytic uremic syndrome: relation to 230. Kasper, C. K. Hereditary plasma clotting factor disorders and their man-
presenting features and clinical outcomes in a prospective cohort of 142 agement. Haemophilia 2000; 6: 13“27.
patients. Blood 2003; 101: 60“8. 231. Strong, J. Bleeding disorders in pregnancy. Curr. Obstet. Gynaecol. 2003;
206. Pivalizza, E. G. Anesthetic management of a patient with thrombotic 13: 1“6.
thrombocytopenic purpura. Anesth. Analg. 1994; 79: 1203“5. 232. Haverkate, F. & Samama, M. Familial dysfibrinogenemia and thrombo-
207. Fesenmeier, M. F., Coppage, K. H., Lambers, D. S., Barton, J. R. & Sibai, philia. Report on a study of the SSC subcommittee on fibrinogen. Thromb.
B. M. Acute fatty liver of pregnancy in 3 tertiary care centers. Am. J. Haemost. 1995; 73: 151.
Obstet. Gynecol. 2005; 192: 1416“19. 233. Inamoto, Y. & Terao, T. First report of case of congenital afibrinogenemia
208. Castro, M. S., Fassett, M. J., Reynolds, T. B., Shaw, K. J. & Goodwin, T. M. with successful delivery. Am. J. Obstet. Gynecol. 1985; 153: 803“4.
Reversible peripartum liver failure: a new perspective on the diagnosis, 234. Goodwin, T. M. Congenital hypofibrinogenemia in pregnancy. Obstet.
treatment, and cause of acute fatty liver of pregnancy, based on 28 con- Gynecol. Surv. 1989; 44: 157“61.
secutive cases. Am. J. Obstet. Gynecol. 1999; 181: 389“95. 235. Girolami, A., Scarano, L., Saggiorato, G. et al. Congenital deficiencies and
209. Anday, E. K. & Cohen, A. Liver disease associated with pregnancy. Ann. abnormalities of prothrombin. Blood Coagul. Fibrinolysis 1998; 9: 557“69.
Clin. Lab. Sci. 1990; 20: 233“8. 236. Catanzarite, V. A., Novotny, W. F., Cousins, L. M. & Schneider, J. M.
210. Samuels, P. & Cohen, A. W. Pregnancies complicated by liver disease and Pregnancies in a patient with congenital absence of prothrombin activity:
liver dysfunction. Obstet. Gynecol. Clin. N. Am. 1992; 19: 745“63. case report. Am. J. Perinatol. 1997; 14: 135“8.
211. Mammen, E. B. Sticky platelet syndrome. Sem. Thromb. Hemost. 1999; 25: 237. Girolami, A., Scandellari, R., Lombardi, A. M. et al. Pregnancy and oral
361“5. contraceptives in factor V deficiency: a study of 22 patients (five homo-
212. Begbie, M. E., Wallace, G. M. F. & Shovlin, C. L. Hereditary haemorrhagic zygotes and 17 heterozygotes) and review of the literature. Haemophilia
telangiectasia (Osler-Weber-Rendu syndrome): a view from the 21st cen- 2005; 11: 26“30.
tury. Postgrad. Med. J. 2003; 79: 18“24. 238. O™Connell, M. P., Eogan, M., Murphy, K. M. et al. Solvent-detergent plasma
213. Swinburne, A. J., Fedullo, A. J., Gangemi, R. et al. Hereditary telangiectasia as replacement therapy in a pregnant patient with factor V deficiency. J.
and multiple pulmonary arteriovenous fistulas: clinical deterioration dur- Mat. Fet. Neonat. Med. 2004; 16: 69“70.
ing pregnancy. Chest 1986; 89: 459“60. 239. Perry, D. J. Factor VII deficiency. Br. J. Haematol. 2002; 118: 689“700.
214. Bevelaqua, F. A., Ordorica, S. A., Lefleur, R. & Young, B. Osler-Weber- 240. Giansily-Blaizot, M., Biron-Andreani, D., Aguilar-Martinez, P. et al.
Rendu disease. Diagnosis and management of spontaneous hemothorax Inherited factor VII deficiency and surgery: clinical data are the best
during pregnancy. N.Y. State J. Med. 1992; 12: 551“2. criteria to predict the risk of bleeding. Br. J. Haematol. 2002; 117: 172“5.
215. Chao, H-S., Chern, M-S., Chen, Y-C. & Chang, S-C. Recurrence of pulmon- 241. Perry, M. G., Herrmann, F. H., Schulman, I. S. et al. Thrombosis
ary arteriovenous malformations in a female with hereditary hemorrhagic in inherited factor VII deficiency. J. Thromb. Haemost. 2002; 1: 2153“8.
telangiectasia. Am. J. Med. Sci. 2004; 327: 294“8. 242. Rizk, D. E. E., Castella, A., Shaheen, H. & Deb, P. Factor VII deficiency
216. Gershon, A. S., Faughnan, M. E., Chon, K. S. et al. Transcatheter embo- detected during pregnancy: a case report. Am. J. Perinatol. 1999; 16: 223“6.
lotherapy of maternal pulmonary arteriovenous malformations during 243. Pehlivanov, B., Milchev, N. & Kroumov, G. Factor VII deficiency and its
pregnancy. Chest 2001; 119: 470“7. treatment in delivery with recombinant factor VII. Eur. J. Obstet. Gynecol.
217. Waring, P. H., Shaw, D. B. & Brumfield, C. G. Anesthetic management of a Reprod. Biol. 2004; 116: 237“8.
parturient with Osler-Weber-Rendu syndrome and rheumatic heart dis- 244. Eskandari, N., Feldman, N. & Greenspoon, J. S. Factor VII deficiency in
ease. Anesth. Analg. 1990; 71: 96“9. pregnancy treated with recombinant factor VIIa. Obstet. Gynecol. 2002; 99:
218. Livneh, A., Langevitz, P., Morag, B., Catania, A. & Pras, M. Functionally 935“7.
reversible hepatic arteriovenous fistulas during pregnancy in patients with 245. Jimenez-Yuste, V., Villar, A., Morado, M. et al. Continuous infusion of
hereditary hemorrhagic telangiectasia. S. Med. J. 1988; 81: 1047“9. recombinant activated factor VII during caesarean section delivery in a
219. Berde, C., Willis, D. C. & Sandberg, E. C. Pregnancy in women with pseu- patient with congenital factor VII deficiency. Haemophilia 2000; 6: 588“90.
doxanthoma elasticum. Obstet. Gynecol. Surv. 1983; 38: 339“44. 246. Lee, J-W. Von Willebrand disease, hemophilia A and B, and other factor
220. Lao, T. T., Walters, B. N. J. & De Swiet, M. Pseudoxanthoma elasticum and deficiencies. Int. Anesth. Clin. 2004; 42: 59“71.
pregnancy. Two case reports. Br. J. Obstet. Gynaecol. 1984; 91: 1049“50. 247. Cox Gill, J. Diagnosis and treatment of von Willebrand disease. Hematol.
221. Viljoen, D. L., Beatty, S. & Beighton, P. The obstetric and gynaecological Oncol. Clin. N. Am. 2004; 18: 1277“99.
implications of pseudoxanthoma elasticum. Br. J. Obstet. Gynaecol. 1987; 248. Kadir, R. A., Lee, C. A., Sabin, C. A., Pollard, D. & Economides, D. L.
94: 884“8. Pregnancy in women with von Willebrand™s disease or factor XI deficiency.
222. Bercovitch, L., Lerous, T., Terry, S. & Weinstock, M. A. Pregnancy and Br. J. Obstet. Gynaecol. 1998; 105: 314“21.
obstetrical outcomes in pseudoxanthoma elasticum. Br. J. Dermatol. 249. Kasper, C. K. Hemophilia of Georgia, U.S.A. Protocols for the treatment of
2004; 151: 1011“18. haemophilia and von Willebrand disease. Haemophilia 2000; 6: 84“93.

5 Other disorders

250. Mannucci, P. M. Treatment of von Willebrand™s disease. N. Engl. J. Med. 268. Girolami, A., Randi, M. L., Gavasso, S., Lombardi, A. M. & Spiezia, F. The
2004; 35: 683“94. occasional venous thromboses seen in patients with severe (homozygous)
251. Giangrande, P. L. F. Management of pregnancy in carriers of haemophilia. FXII deficiency are probably due to associated risk factors: a study of
Haemophilia 1998; 4: 779“84. prevalence in 21 patients and review of the literature. J. Thromb.
252. Dhar, P., Abramovitz, S., DiMichele, D., Gibb, C. B. & Gadalla, F. Thrombolysis 2004; 17: 139“43.
Management of pregnancy in a patient with severe haemophilia A. Br. 269. Burrows, R. F., Fay, J. G. & Burrows, E. A. Bleeding risk and reproductive
J. Anaesth. 2003; 91: 432“5. capacity among patients with factor XIII deficiency: a case presentation
253. Russell, Z., Riconda, D., Pollack, L., O™Leary, T. D. & Carlan, S. J. and review of the literature. Obstet. Gynecol. Surv. 2000; 55: 103“8.
Thrombosis in a pregnant hemophilia A carrier after intrapartum recom- 270. Inbal, A. & Muszbek, L. Coagulation factor deficiencies and pregnancy
binant factor VIII. Obstet. Gynecol. 2005; 105: 875“6. loss. Semin. Thromb. Hemost. 2003; 29: 171“4.
254. Fukada, Y., Shima, T., Kawashima, S., Hirata, S. & Hoshi, K. Heterozygous 271. Shetty, S., Madkaikar, M., Nair, S. et al. Combined factor V and VIII
hemophilia developed during pregnancy. J. Obstet. Gynaecol. Res. 2005; 31: deficiency in Indian population. Haemophilia 2000; 6: 504“7.
50“1. 272. McMahon, M. J. & James, A. H. Combined deficiency of factors II, VII, IX,
255. Briet, E., Reisner, H. M. & Blatt, P. M. Factor IX levels during pregnancy in a and X (Borgschulte-Grigsby deficiency) in pregnancy. Obstet. Gynecol.
woman with hemophilia B. Haemostasis 1982; 11: 87“9. 2001; 97: 806“8.
256. Guy, G. P., Baxi, L. V., Hurlet-Jensen, A. et al. An unusual complication in a 273. Cohen, S., Daitch, J. S., Amar, D. & Goldiner, P. L. Epidural analgesia for
gravida with factor IX deficiency: case report with review of the literature. labor and delivery in a patient with von Willebrand™s disease. Reg. Anesth.
Obstet. Gynecol. 1992; 80: 502“5. 1989; 14: 95“7.
257. Yang, M. Y. & Ragni, M. V. Clinical manifestations and management of 274. Milaskiewicz, R. M., Holdcroft, A. & Letsky, E. Epidural anaesthesia and
labor and delivery in women with factor IX deficiency. Haemophilia von Willebrand™s disease. Anaesthesia 1990; 45: 462.
2004; 10: 483“90. 275. Cohen, S. & Zada, Y. Neuraxial block for von Willebrand™s disease. (letter)
258. Romagnolo, C., Burati, S., Ciaffoni, S. et al. Severe factor X deficiency in Anaesthesia 2001; 56: 397.
pregnancy: case report and review of the literature. Haemophilia 2004; 10: 276. Jones, B. P., Bell, E. A. & Mohammed, M. Epidural labor analgesia
665“8. in parturient with von Willebrand™s disease type IIA and severe pree-
259. Brody, J. I. & Finch, S. C. Improvement of factor X deficiency during preg- clampsia. Anesthesiology 1999; 90: 1219“20.
nancy. N. Engl. J. Med. 1960; 263: 996“9. 277. Hepner, D. L & Tsen, L. C. Severe thrombocytopenia, type 2B von
260. Konje, J. C., Murphy, P., De Chazal, R., Davidson, A. & Taylor, D. Severe Willebrand disease and pregnancy. Anesthesiology 2004; 101: 1465“7.
factor X deficiency and successful pregnancy. Br. J. Obstet. Gynaecol. 1994; 278. Inwood, M. J. & Meltzer, D. B. The female carrier of haemophilia “ a
101: 910“11. problem for the anaesthetist. Can. Anaesth. Soc. J. 1978; 25: 266.
261. Kumar, M. & Mehta, P. Congenital coagulopathies and pregnancy: report of four 279. Paidas, M. J., De-Hui, W. K., Langhoff-Roos, J. & Arkel, Y. S. Inherited
pregnancies in a factor X-deficient woman. Am. J. Hematol. 1994; 46: 241“4. thrombophilias and adverse pregnancy outcome: screening and manage-
262. Hurria, K., Castellone, D., Peerschke, E. I. B. & Asch, A. Factor X deficiency ment. Sem. Perinatol. 2005; 29: 150“63.
and pregnancy. Lab. Med. 2003; 34: 302“3. 280. Jordaan, D-J., Shoon, M. G. & Badenhorst, P. N. Thrombophilia screening
263. Bofill, J. A., Young, R. A. & Perry, K. G. Successful pregnancy in a woman in pregnancy. Obstet. Gynecol. Surv. 2005; 60: 394“404.
with severe factor X deficiency. Obstet. Gynecol. 1996; 88: 723. 281. Confidential Enquiry into Maternal and Child Health. Why Mothers Die
264. Connelly, N. F. & Brull, S. J. Anesthetic management of a patient with 2000“2002. London: RCOG Press. 2004.
Factor XI deficiency and Factor XI inhibitor undergoing a cesarean sec- 282. Greer, I. A. & Nelson-Piercy, C. Low-molecular-weight heparins for throm-
tion. Anesth. Analg. 1993; 76: 1365“6. boprophylaxis and treatment of venous thromboembolism in pregnancy:
265. Salomon, O., Steilberg, D. M., Tamarin, I., Zivelin, A. & Seligsohn, U. Plasma a systematic review of safety and efficacy. Blood 2005; 106: 401“7.
replacement therapy during labor is not mandatory for women with severe 283. van Selm, M., Kanhai, H. H. H. & Gravenhorst, J. B. Maternal hydrops
factor XI deficiency. Blood Coagul. Fibrinolysis 2005; 16: 37“41. syndrome: a review. Obstet. Gynecol. Surv. 1991; 46: 785“8.
266. David, A. L., Paterson-Brown, S. & Letsky, E. A. Factor XI deficiency present- 284. Vidaeff, A. C., Pschirrer, E. R., Mastrobattista, J. M. et al. Mirror syndrome.
ing in pregnancy: diagnosis and management. B. J. O. G. 2002; 109: 840“3. A case report. J. Reprod. Med. 2002; 47: 770“4.
267. Pauer, H-U., Burfeind, P., Kostering, H., Emons, G. & Hinney, B. Factor XII 285. Mizrahi-Arnaud, A., Wilkins Haug, L., Marshall, A. & Silva, V. Maternal
deficiency is strongly associated with primary recurrent abortions. Fertil. mirror syndrome after in utero aortic valve dilation. A case report. Fetal
Steril. 2003; 80: 590“4. Diagn. Ther. 2006; 21: 439“43.

Gabriela Rocha Lauretti and Robert S. F. McKay

Bacterial infections exposure to inflammation can induce lung maturation. The fetus
at risk of early preterm delivery may be exposed to chorioamnio-
Clinical features: fever and asymptomatic patient
nitis and glucocorticoids. This may increase or decrease fetal
Fever during pregnancy can result from a variety of infections, inflammatory response, depending on when exposure occurs.
tissue trauma, malignancy, epidural analgesia, drug administra- The immunomodulatory capacity of the fetus remains unexplored.
tion, and endocrine or immunologic disorders. Infection is the An increased risk of septicemia and puerperal fever in women
most common cause, reflecting the effect of pyrogens on the undergoing cesarean section (C/S) is one reason why vaginal
hypothalamus.1 Bacterial infections of the skin, periodontal tis- delivery is the preferred delivery mode for healthy women.
sues, respiratory and genitourinary tracts can lead to pregnancy-
related complications such as preterm labor, premature rupture of
Anesthetic management of the septicemic
membranes, abortion following pelvic inflammatory disease,
chorioamnionitis, neonatal infections, cervicitis, urethritis, ecto-
pic pregnancy, low birthweight, stillbirth, pneumonia, septice- Anesthesia with concurrent sepsis involves serious physiological
mia,2,3 and both maternal and neonatal death. Urinary tract stress upon multiple organ systems. However, pregnant patients
bacterial infections usually arise from preexisting covert bacter- may be protected during sepsis by oxytocin, which limits sepsis-
iuria and experts recommend screening and eradication of these induced oxidative damage by acting as an antioxidant agent.
silent infections as routine prenatal practice.4 Antibiotic treatment Oxytocin has a protective effect on the colon and liver that may
during pregnancy is beneficial in reducing neonatal and maternal be dependent on its inhibitory effect on neutrophil infiltration,
limiting sepsis-associated multiple organ damage.29 The clinical
morbidity/mortality, and most bacterial infections are preventable
and treatable.4,5,6,7,8 Clindamycin in early pregnancy can reduce importance of oxytocin in this regard is unknown. Correction of
the risk of preterm birth by 40“60%.2 Vaginal bacterial diseases are perioperative hypothermia may improve survival after sepsis by
modulating early inflammatory responses.30
often asymptomatic and have little impact on management by the
obstetric anesthesiologist. The more common bacterial infections When anesthetizing a septic parturient, assess intravascular
and related complications are listed in Table 18.1. volume, to include invasive monitoring in severe cases. Antibiotic
therapy should be initiated before any anesthetic intervention. The
need for emergency C/S must be weighed against the need for
Maternal and fetal implications
preoperative fluid resuscitation of the mother. Infection in preg-
The incidence of maternal infection during labor has been estimated nancy raises questions about the safety of regional anesthesia in
to be about 3%.22 Severe sepsis is less common, however, and pre- febrile patients. Despite this concern and a lack of guidelines, the
sents as the primary problem in < 1% of patients.23 However, sepsis presence of infection and fever in labor is not an absolute contra-
remains a significant cause of maternal death in underdeveloped indication to regional anesthesia. Indeed, epidural analgesia has
countries.24 In pregnancy, there are decreases in immunoglobulin G been associated with improved neonatal acid-base status,31 and, in
levels, lymphocyte count, and impaired lymphocyte activity. Further, endotoxemic rats, produces better redistribution of organ blood
flow.32 However, inducing epidural anesthesia in the presence of
a change in the balance of Th1/Th2-type cytokines favors T helper
type 2 immunity,25 and leads to an increase in asymmetric anti- sepsis remains controversial. Sympathetic block induced by neur-
bodies.26 Although these changes promote maternal tolerance of the axial anesthesia may be disastrous in a septic, hypovolemic par-
fetus, they also may place the parturient at added risk for infection. turient. Epidural anesthesia titrated for labor or nonurgent C/S is
Maternal complications of sepsis include pneumonia, adult acceptable if intravascular volume has been optimized. Epidural
anesthesia has been associated with a slightly longer labor,33 which
respiratory distress syndrome (ARDS), disseminated intravascular
may contribute to maternal fever.34 Although fever associated with
coagulation (DIC), pulmonary edema, septic pulmonary emboli,
septic shock, decreased left ventricular function, and cardiac arrest. epidurals is unlikely to adversely affect the fetus, epidural analgesia
Five percent of septic shock cases in the obstetric population are has been associated with increased rates of neonatal sepsis evalua-
tion in some institutions.35 Hence, criteria for these evaluations
caused by gram-positive bacteria and 95% by gram-negative
organisms.18 The diagnosis is made by attention to the history, need to be adjusted in the presence of epidural anesthesia.
physical examination, and laboratory findings (see Table 18.2). For emergency C/S, use a rapid-sequence general anesthetic
It is uncertain if the preterm fetus can develop an inflammatory induced with intravenous (i.v.) ketamine 1“2 mg/kg and succinyl-
response and modulate inflammation to prevent injury. Fetal choline 1 mg/kg, and, if required, concomitant fluid resuscitation

Obstetric Anesthesia and Uncommon Disorders, eds. David R. Gambling, M. Joanne Douglas and Robert S. F. McKay. Published by Cambridge University Press.
# Cambridge University Press 2008.
5 Other disorders

Table 18.1 Bacterial infections

Etiological agent Related complications of interest

Complex vaginal infection; increased susceptibility during pregnancy;9 incidence of endometritis after C/S varies
Bacterial vaginosis (Gardnerella
vaginalis, Ureaplasma from 3“95%, even in patients receiving prophylactic antibiotics.
urealyticum, Mycoplasma
hominis, Mobiluncus species,
Bacteroides bivius)
Neisseria gonorrhoeae Increased in women with lowered immunity, commonly associated with HIV; increased in women on birth control
pills; rarely may lead to systemic sepsis, endocarditis, and/or arthritis; pharyngitis from oral sex is possible; alters
the inflammatory responses elicited in human infection.10
Chlamydia species Three species of the genus Chlamydia are pathogenic in humans and cause pneumonia. C. pneumoniae leads to
pneumonia in adults and may be associated with intrauterine growth restriction (IUGR) and peripartum

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