Peri- and Postpartum Management of Patients With Factor XI Deficiency

Area of Science:

• Hematology
• Obstetrics
• Genetics

Background:

• Factor XI (FXI) deficiency is a rare bleeding disorder.
• Its variable bleeding phenotype complicates peripartum management.
• Effective strategies are needed for managing pregnant women with FXI deficiency.

Purpose of the Study:

• To review the experience of pregnant women with FXI deficiency.
• To identify strategies for minimizing hemostatic agent use.
• To increase the utilization of neuraxial anesthesia in this population.

Main Methods:

• Retrospective review of 28 pregnant women with FXI deficiency.
• Data collected: bleeding events, obstetric history, peripartum management, FXI activity.
• Analysis of 64 pregnancies from January 2006 to August 2018.

Main Results:

• Median FXI activity was 42 IU/dL; 17% of pregnancies resulted in loss.
• Postpartum hemorrhage occurred in 17% of pregnancies.
• Neuraxial anesthesia was safely administered in 59% of deliveries.

Conclusions:

• Most pregnancies in women with FXI deficiency are uncomplicated.
• Minimal hemostatic support is often sufficient.
• Neuraxial anesthesia is a safe option for most women with FXI deficiency.