A 32-year-old primigravida, 38 weeks' gestation, admitted to hospital for rupture of membranes.
Her personal history included Klippel-Trenaunay syndrome, with involvement of the right lower limb, in which an increase in diameter and length could be observed, with the presence of a flat angioma on the anteroexternal side of the thigh, striking venous varicosities, both on the thigh and right leg, and trophic skin disorders that mainly affected the distal area of the leg.
Followed up by the vascular surgery service, she did not receive any medical treatment, except for local topical products for the care of the skin disorders on her right leg.
She provided a report describing the lesions that the patient presented; it also excluded the involvement of the contralateral lower limb, as well as the existence of vascular malformations at other levels. She had not presented any complications as a consequence of her underlying disease, with the exception of skin involvement due to circulatory stasis.
The patient requested epidural analgesia for labour; at that time she had 3 cm of cervical dilatation, there was effective uterine dynamics and the foetus was reactive, with no evidence of foetal distress. Laboratory data showed a haemogram with platelets 136,000, haemoglobin 10.9, with the rest of the parameters being normal; the coagulation study and basic biochemistry were normal.
After signing the consent form and explanation of the procedure, it was decided to place a 20G epidural catheter using an 18G Tuohy needle at the level of the L3-L4 space, and the technique was performed without incident.
Test doses of 5 ml of bupivacaine 0.25% with epinephrine and an initial bolus of 8 ml of bupivacaine 0.25% without vasoconstrictor and 100 mg of fentanyl were administered without incident. Bupivacaine 0.0625% was perfused with 2 µg.ml-1 of fentanyl, between 15-20 ml.h-1, achieving very satisfactory analgesia until the end of labour.
Euthocic delivery was achieved, which required episiotomy, and the product of gestation was a male newborn weighing 2,695 g, with an Apgar test of 9-10.
In the immediate postpartum period, the epidural catheter was removed without incident.
At 12 h after delivery, and taking into account the high risk of thromboembolic phenomena, low molecular weight heparin was administered s.c., prophylactically as indicated by obstetrics, without incident. This treatment was maintained until the patient was discharged on the 3rd postpartum day.
The patient was assessed 24 hours after delivery and telephoned one week after hospital discharge, without any incident and/or complication related to epidural analgesia.
The degree of satisfaction with the analgesic technique used was optimal.