Primigesta, 32 years old, 38 weeks gestation, admitted to hospital due to rupture of membranes.
His personal history included a Klippel-Trenaunay syndrome, with involvement of the right lower limb, in which he could objectify the increase of diameter and length of the same, with the presence of a distal thigh angioma.
During follow-up at the vascular surgery service, she did not undergo any medical treatment, except for local topical products for the care of cutaneous disorders of her right side.
A report describing the lesions presented by the patient was provided, as well as the involvement of the contralateral lower limb, as well as the existence of vascular malformations at other levels.
He had no complications as a result of his underlying disease, except for the skin condition caused by circulatory stasis.
The patient requested epidural analgesia for delivery; at this time she presented 3 cm of cervical dilation, effective uterine dynamics existed and the fetus was reactive, with no data of fetal distress.
Laboratory data showed a blood count with platelets 136,000, hemoglobin 10,9, with the rest of the normal parameters; coagulation study and basic biochemistry were normal.
After signing the consent and explaining the procedure, it was decided to place a 20G epidural catheter using an 18G Tuohy needle at the level of the L3-L4 space, performing the technique without incidents.
Test doses of 5 ml of 0.25% bupivacaine with epinephrine and an initial bolus of 8 ml of 0.25% bupivacaine without vasoconstrictor and 100 mg of fentanyl were administered without incidents.
Bupivacaine 0.0625% was used with fentanyl 2 μg.ml-1 between 15-20 ml.h-1, with very satisfactory analgesia until the end of labor.
She underwent cesarean section and required episiotomy. The product of pregnancy was a male newborn weighing 2,695 g, with an Apgar score of 9-10.
In the immediate puerperium, an epidural catheter was removed without incidents.
Twelve hours after delivery, and considering the high risk of thromboembolic events, low molecular weight heparin s.c. was administered prophylactically according to the obstetric indication, with no incidents.
This treatment was maintained until the patient was discharged on the third day postpartum.
The patient was assessed 24 hours after delivery and telephoned one week after discharge, without any incidence and/or complications related to epidural analgesia.
The degree of satisfaction with the analgesic technique used was optimal.
