Background and Aims:
Obstetric cholestasis affects 0.7% of pregnancies in multi-ethnic women. Coagulopathy may develop due to decreased vitamin K absorption which is needed for activating clotting factors in obstetric cholestasis. The Association of Anaesthetists of Great Britain and Ireland guidelines recommends to check coagulation before any regional techniques in these patients .We have done an audit in our hospital to evaluate our practice of testing for coagulation and to compare with national guidelines.
Methods:
We have collected data retrospectively after approval from our audit department . We have collected data of patients who are diagnosed with obstetric cholestasis from June 2016 to May 2018.The data collected on excel sheet were number of patients who had coagulation tests done, number of patients who had regional techniques,number of patients who had coagulation tests done during antenatal period and within 24hrs of regional technique,number of patients with INR ( international normalised ratio ) > 1.4.
Results:
We had done analyses of 175 patients. 90 patients had coagulation tests.Out of 65 patients who had regional techniques, 31 had Spinal anaesthesia, 32 had Epidural anaesthesia and two patients had Epidural and Spinal anaesthesia.Coagulation tests were done in 27 patients who had regional technique during antenatal period and only 10 patients within 24hrs of regional technique. None of the patients has INR >1.4.
Conclusions:
We are less compliant with national guidelines as 27 (41%) of patients who had coagulation tests  during antenatal period and 10 patients had tests within 24hrs of regional technique.Our recommendations were coagulation tests to be done on admission to delivery suite, update our local guidelines after discussion with obstetricians and re-audit.

COAGULOPATHY DUE TO OBSTETRIC CHOLESTASIS IN PATIENTS UNDERGOING REGIONAL TECHNIQUES