Hemophilia C management in obstetric anesthesia

Area of Science:

• Obstetric Anesthesia
• Hematology
• Coagulation Disorders

Background:

• Coagulation alterations pose risks in obstetric anesthesia, potentially contraindicating neuraxial techniques and exacerbating postpartum hemorrhage.
• Prompt recognition and management of coagulopathies are crucial for patient safety during childbirth.

Observation:

• A parturient presented with severe factor XI deficiency during labor.
• Neuraxial techniques and NSAIDs were contraindicated; remifentanil patient-controlled analgesia was used for pain relief.
• Factor XI concentrate was unavailable, necessitating treatment with tranexamic acid and fresh frozen plasma.

Findings:

• Cesarean section under general anesthesia was performed due to labor progression failure.
• Uterine atony occurred intraoperatively, managed with uterine massage and uterotonics.
• The patient remained hemodynamically stable throughout the procedure.

Implications:

• This case highlights the importance of multidisciplinary collaboration in managing obstetric patients with rare bleeding disorders.
• Effective pain, coagulation, and hemorrhage management strategies are essential for favorable maternal outcomes.
• Awareness of factor XI deficiency (Hemophilia C) and its obstetric implications is critical for anesthesiologists and obstetricians.