skip to main content

Labour analgesia with therapeutic LMWH — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

ModerateObstetric AnaesthesiaLabour analgesia with therapeutic LMWHFRCA Final

A woman in labour requests an epidural. She received therapeutic enoxaparin for a recent pulmonary embolus 10 hours ago, has normal platelets, and is contracting every three minutes. She is distressed despite Entonox. What is the most appropriate pain management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Use non-neuraxial analgesia until the anticoagulant interval is safe

Therapeutic LMWH within the preceding 24 hours is a contraindication to neuraxial procedures because of vertebral canal haematoma risk. Atraumatic technique and smaller needles do not sufficiently mitigate this risk. Protamine does not create a safe routine pathway for labour epidural insertion. Alternatives include remifentanil PCA where suitable, systemic opioids and supportive measures until neuraxial timing is safe.

Reference: Association of Anaesthetists regional anaesthesia and coagulation guideline 2021; OAA labour analgesia guidance