labor epidural and RPR

[apma77]

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If patient is RPR positive (not specific but sensitive marker) what is your criteria for placing epidural??

any evidence on this topic out there?

 

[coprolalia]

RPR (assuming you are thinking syphillis) is not specific and means nothing unless you follow it up with a VDRL or FTA-ABS. In other words, no contraindication in placing an epidural.

-copro

 

[apma77]

can you point out any literature to back this up? like an anesthesia text that states its OK to place the epidural in this situation??

 

[coprolalia]

Can you point to any literature that says it isn't?

-copro

 

[radslooking]

are you worried about neurosyphilis? i wouldnt think anesthesia, even if directly administered during a spinal, much less an epidural should be a contraindication. the disease is already systemic....in the very rare chance they have such an advanced case of syphilis. why did anyone draw an RPR anyway?

 

[Planktonmd]

can you point out any literature to back this up? like an anesthesia text that states its OK to place the epidural in this situation??

You are not going to find data on this specific subject because there isn't any.
Here is how I see it:
A positive RPR in a pregnant woman usually is confirmed by more specific tests and if the diagnosis of Syphilis was confirmed they are usually started on Penicillin which removes the parasite from the blood stream very quickly ( one dose of Benzatine penicillin is enough to do that in primary or secondary Syphilis), even in tertiary syphilis or in neurosyphilis PCN will eliminate the parasitemia although it might take longer.
So if the patient has been treated with PCN (which is usually the case) and she doesn't have neurosyphilis or tabes dorsalis then this is similar to any treated infection or treated bacteremia where most people agree that you should not deny the epidural.
If she has neurosyphilis or tabes dorsalis then some people might hesitate in placing the epidural since local anesthetic toxicity might be a problem but many people would still proceed with the epidural but use dilute solutions
So, the short answer is: if they are treated with PCN most likely you should not have a problem with the epidural.