Swine flu and clexane vexation

We recently discussed the issues of the parturient with anticoagulants or infection. The management of the parturient with severe influenza was particularly raised.

In a timely and practical way this month's IJoA has a review and a case report on these very topics.
In summary, European and U.S guidelines indicate that enoxaparin can/should be given as early as two hours after neuraxial block. As I have earlier discussed, enoxaparin given less than six hours after surgery increases haemorrhage without decreasing thrombosis compared to giving it between 6 to 12 h after surgery. Beyond 12 hours after surgery the risk of thrombosis increases. So enoxaparin 40 mg 8 - 10  hours after block seems to be a sensible time to enable the caesar wounds to clot and also provide antithrombotic effect.

The case report is of an obese, smoking parturient with H1N1 influenza. An epidural was placed in labor without intrapartum or postpartum complication. The case report discusses the issue of neuraxial block in the presence of viraemia and the possible consequence of meningoencephalitis. The risk seems more in theory than in what has been experienced, but caution is still recommended in the overtly viremic patient, and the use of a CNB should be justifiable by the potential benefit.