National survey on clinical practice in obstetric analgesia in Spain.

INTRODUCTION: A national survey was conducted among maternity hospitals nationwide to understand the variability in clinical practice for obstetric analgesia and to reach a consensus on optimal care in the future in Spain. MATERIALS AND METHODS: Spanish experts in obstetric anesthesiology designed a survey on the practice of obstetric analgesia during childbirth, following a Delphi process. The survey was sent to 195 Spanish maternity hospitals between April and September 2022 using Google Forms. A descriptive study of the results was performed. RESULTS: Responses were obtained from 108 centres (55.4%), of which 88 (83.8%) were public hospitals. The most commonly used technique was epidural analgesia in 97 (92.4%) centres. Nine (8.6%) centres used the combined spinal-epidural (CSE) technique, 5 (4.8%) used spinal analgesia, and 3 (2.9%) used dural puncture epidural (DPE) analgesia. The most commonly used local anaesthetic was levobupivacaine 0.1-0.25% in 82 (78.1%) centres. Fentanyl or sufentanil were added to the local anaesthetic in 96 (91.4%) centres. Epidural maintenance was performed with continuous epidural infusion (CEI) + patient-controlled epidural analgesia (PCEA) or programmed intermittent epidural bolus (PIEB) + PCEA in 64 (60.9%) and 33 (30.5%) centres, respectively. Fifteen (14.3%) centres lacked alternative techniques to epidural analgesia and 25 (23.8%) did not follow obstetric analgesia protocols. CONCLUSION: Despite the variability in clinical practice for obstetric analgesia in Spain, the vast majority of centres follow recommendations in this field. There is room for improvement, which should be considered a fundamental strategy for progressing towards excellence.

[Anesthetic management in a pregnant woman suffering from idiopathic thrombocytopenic purpura]. / Manejo anestésico en gestante afecta de púrpura trombocitopénica idiopática.

Idiopathic thrombocytopenic purpura is an autoimmune disorder characterized by a low platelet count. Onset usually occurs during adolescence with episodes of cutaneous and mucosal bleeding. Thrombocytopenia during pregnancy is associated with many diseases, of which idiopathic thrombocytopenic purpura is the most common in the first trimester. The need for treatment will depend on the platelet count and whether there is bleeding. At the end of pregnancy, however, whether delivery is vaginal or by cesarean, more aggressive therapeutic measures are required. Anesthetic management in this type of patient will be determined by coagulation status and platelet count, and local or regional anesthesia may be contraindicated. We report the case of a pregnant woman with idiopathic thrombocytopenic purpura who was admitted to the emergency department of our hospital with suspected preeclampsia.

Manejo anestético en gestante afecta de púrpura trombocitopénica idiopática / Anesthetic management in a pregnant woman suffering from idiopathic thrombocytopenic purpura

La púrpura trombocitopénica idiopática (PTI) es untrastorno autoinmune, caracterizado por plaquetopenia,que suele debutar durante la adolescencia y que cursa enforma de brotes con episodios de sangrado cutáneomucoso.Existen muchas patologías asociadas a trombocitopeniadurante la gestación, siendo la PTI la más frecuentedurante el primer trimestre del embarazo. Lanecesidad de tratamiento dependerá del recuento de plaquetasy de la presencia de clínica hemorrágica. Sinembargo, cuando finaliza la gestación (tanto vía vaginalcomo cesárea) hay que tomar medidas terapéuticas másagresivas. El manejo anestésico de este tipo de pacientesvendrá determinado por el estado de la coagulación y elrecuento plaquetar, puediendo estar contraindicada unaanestesia locorregional. Presentamos el caso de una gestanteafecta de PTI que acudió al servicio de urgenciasde nuestro centro por sospecha de preeclampsia(AU)

Idiopathic thrombocytopenic purpura is anautoimmune disorder characterized by a low plateletcount. Onset usually occurs during adolescence withepisodes of cutaneous and mucosal bleeding.Thrombocytopenia during pregnancy is associated withmany diseases, of which idiopathic thrombocytopenicpurpura is the most common in the first trimester. Theneed for treatment will depend on the platelet count andwhether there is bleeding. At the end of pregnancy,however, whether delivery is vaginal or by cesarean, moreaggressive therapeutic measures are required. Anestheticmanagement in this type of patient will be determined bycoagulation status and platelet count, and local or regionalanesthesia may be contraindicated. We report the case ofa pregnant woman with idiopathic thrombocytopenicpurpura who was admitted to the emergency departmentof our hospital with suspected preeclampsia(AU)