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Anesthetic management with labor epidural analgesia of the parturient with severe factor VII deficiency: a case report
  1. Benjamin Hyers1,
  2. Camila Cabrera2,
  3. Christopher Walsh3,
  4. Anusha Reddy1,
  5. Talia Strulowitz1,
  6. Joshua Hamburger1,
  7. Nakiyah Knibbs1,
  8. Daniel Katz1,2,
  9. Lauren Ferrara2 and
  10. Yaakov Beilin1,2
  1. 1Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  2. 2Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  3. 3The Mount Sinai Hemophilia Center, The Mount Sinai Hospital, New York, New York, USA
  1. Correspondence to Dr Benjamin Hyers, Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; benjamin.hyers{at}mountsinai.org

Abstract

Background Factor VII deficiency is considered a contraindication to neuraxial anesthesia due to the risk of an epidural hematoma.

Case Report A 32 year old G1P0 parturient with severe factor VII deficiency presented for an anesthesiology consultation at 32 weeks gestation. Initial coagulation studies were significant for an elevated INR (2.0) and a low factor VII level of 6%. After interdisciplinary discussion, it was decided that neuraxial analgesia could be offered if her coagulation studies corrected after administration of recombinant activated factor VII (rFVIIa). The patient presented at 36 weeks gestation for a rFVIIa challenge. She received 22 mcg/kg rFVIIa and coagulation studies were analyzed 20 minutes later which showed complete correction of the coagulopathy. The patient presented to the hospital at 39 weeks and 3 days for delivery, received 2 mg rFVIIa and 20 minutes later, successfully received an epidural catheter. Her INR was monitored every 3 hours during her labor course and rFVIIa was given if the INR was 1.3 or greater. She required three additional doses over 22 hours. No bleeding or thrombotic events occurred, and the patient was discharged home without complications.

Conclusion This case highlights the safe management of an epidural catheter in a parturient with severe factor VII deficiency.

  • Pain Management
  • Obstetrics
  • analgesia

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Footnotes

  • Contributors BH: involved in antepartum anesthesiology consultation, involved in all drafts of the paper, reviewed and edited final manuscript. CC: helped write first draft of paper and reviewed final manuscript. CW: hematologist, developed recommendations for rFVIIa administration during labor and delivery, edited and reviewed final manuscript. AR: helped write first draft of paper, involved in antepartum anesthesiology consultation, edited and reviewed final manuscript. TS: edited and reviewed final manuscript. JH: edited and reviewed final manuscript. NK: edited and reviewed final manuscript. DJK: edited and reviewed final manuscript. LF: maternal fetal medicine obstetrician, coordinated all obstetrical care for this patient, edited and reviewed final manuscript. YB: senior author, involved in all drafts of the paper, coordinated all anesthesia care for this patient including antepartum anesthesiology consultation, reviewed final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.