Excessive Subcutaneous Bleeding After Continuous Labor Epidural Placement.

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Medically Challenging Case Report Poster 


Muhammad Anwar  
Tulane Univeristy School of Medicine


Peter Foldes  
Tulane Univeristy Medical Center


A 27 years old (G3P0) patient with a PMH of MVR in 2013 presented for induction. Anticoagulation was bridged with Enoxaparin then Heparin 10K Units BID. Labor induction commenced, heparin was held. Her coagulation profile was within normal limits. A single attempt epidural was placed. Three hours later, she presented with persistent bleeding from the catheter site. Bleeding continued despite several dressing changes and applied pressure. A vaginal delivery ensued. A purse-string suture and pressure dressings with SURGICEL® were placed at the catheter exit site. A CT angiogram found no bleeding source or epidural hematoma. The catheter was removed without incident, and anticoagulation restarted. EBL was 250mL. She was discharged on POD3.
Supporting Image: CTA.JPG
   ·Lumbar Spine CT Angiogram

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Enter up to two references.

1. Horlocker, Terese, T.; Vandermeuelen, Erik; Kopp, Sandra, L.; Gogarten, Wiebke; Leffert, Lisa, R.; Benzon, Honorio, T. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition). Regional Anesthesia and Pain Medicine. April 2018 - Volume 43 - Issue 3 - p 263–309