Spinal anaesthesia and dysfibrinogenaemia

Area of Science:

• Obstetrics and Gynecology
• Anesthesiology
• Hematology

Background:

• Triplet pregnancies increase obstetric risks, including postpartum hemorrhage.
• Dysfibrinogenemia is a rare inherited bleeding disorder affecting fibrinogen function.
• Central neural blockade is often cautioned in patients with bleeding disorders due to potential complications.

Purpose of the Study:

• To report a case of spinal anesthesia in a patient with undiagnosed dysfibrinogenemia during a triplet pregnancy.
• To discuss the safety and outcomes of central neural blockade in patients with fibrinogen disorders.
• To review the literature for similar cases and anesthetic considerations.

Main Methods:

• Case report of a 34-year-old woman with a triplet pregnancy.
• Elective cesarean section performed under spinal anesthesia.
• Management of massive postpartum hemorrhage.
• Postoperative investigation and diagnosis of dysfibrinogenemia.

Main Results:

• The patient underwent cesarean section under spinal anesthesia without immediate complications.
• Massive postpartum hemorrhage occurred, leading to the diagnosis of dysfibrinogenemia.
• No neurological sequelae were observed following spinal anesthesia.
• Family members were also identified with dysfibrinogenemia.

Conclusions:

• Central neural blockade may be feasible in selected patients with dysfibrinogenemia, even in high-risk obstetric scenarios.
• Careful patient selection and multidisciplinary management are crucial when considering neuraxial anesthesia in patients with bleeding diatheses.
• This case suggests that contraindications for central neural blockade in dysfibrinogenemia may warrant re-evaluation.