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C-section, subdural haematoma, spinal epidural. Risk in future pregnancies ?

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Practicing since : 2005
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My wife had a subdural haematoma following a planned c section in Dec of last year. Drs were unable to pin down the exact cause, but as she is in her 20s (i.e. not elderly with thin blood), has no pre-existing medical conditions, her blood tests show that her blood's clotting properties are normal and suffered no damage to any blood vessels after CT and MRI examinations. The cause was put down to a spinal epidural and exhaserbated by the administration of Clexane to reduce the incidence of clots in her legs and lungs.

This has naturally made her very nervous about future pregnancies and wants to find out if it is possible this could happen again in a normal vaginal birth without the administration of clexane or a spinal epidural. Secondly what would be the protocol for starting a normal vaginal birth and then developing complications that would require an emergency c section - i.e. is it likely a spinal epidural would be administered along with blood thinning drugs similar to Clexane
Posted Sat, 14 Apr 2012 in Child Birth
Answered by Dr. Rhea Chanda 25 minutes later

Thanks for the query.

Let me address your concerns one at a time.

Subdural hematoma rarely occurs without head trauma or in young individuals.
If this complication occurred due to the spinal anesthesia during the c section,then its not directly related with the pregnancy.So any future pregnancies that might happen will be independent of this complication.

What I meant is it may or may not happen regardless of the pregnancy.For instance,it could occur due to any other surgery or trauma and very rarely,spontaneously.
Whether she will have vaginal births or c sections is another matter altogether.
That will depend on various factors including the maternal and fetal risk factors.Any pregnant woman will go into labor at full term,but whether that can done or not depends on factors like the maternal health,liquor status,position of the fetus.

It will be your OB's call to make at the last minute.If all is well,and there are no contraindications there vaginal birth is possible.On the other hand,any development of complications could demand surgery.Then,again risk of anesthesia complications arise.

I would also like to stress that this particular complication is very uncommon.Normally in a healthy young woman,this should not happen.If no underlying causes have been identified then,it can be brought down to anesthesia complications or spontaneous.
It is only at the OR that it can be determined what drugs will be needed depending on the patients condition.

It is not normal protocol to administer blood thinners during any surgery.
Vaginal births are also not known to cause spontaneous hematomas.You have mentioned that all her labs are normal.

To summarize,if you and your wife would like more children,then it will have to be a informed decision on your part,after considering the possibility of complications during surgery or anesthesia.Its not necessary that these complications will occur again,but however minimal,the chances are there.Especially since we couldn't identify any underlying cause.

Hope that answers your query.

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