TABLE 6.
Postpartum hemorrhage in women with congenital FVII deficiency
| FVII:C level | Prophylaxis prior to delivery | Delivery | Postpartum hemorrhage | Management of postpartum hemorrhage | Reference | |
|---|---|---|---|---|---|---|
| 1 | 30 IU/dl baseline/60 IU/dl at term | rFVIIa (IV) | Caesarean delivery under epidural | 1400 ml blood loss | Not stated | [53] |
| 2 | 1% baseline/<1% third trimester | rFVIIa (IV) | Vaginal delivery at 38 weeks with remifentanil patient‐controlled analgesia (induced due to pre‐eclampsia) | Second‐degree laceration, 800 mL blood loss | Not stated | [16] |
| 3 | 10% baseline/16% third trimester | None | Caesarean delivery at 38 weeks under general anesthesia (induced due to oligohydramnios, induction failed) | Uterine atony, 1000 ml blood loss | Misoprostol (oral), hemabate (IM), TXA | [16] |
| 4 | 7% baseline/16% third trimester | TXA, rFVIIa (IV) | Caesarean delivery at 38 weeks under general anesthesia (induced due to gestational hypertension, induction failed) | Uterine atony, 800 ml blood loss | Misoprostol (oral), hemabate (IM) | [16] |
| 5 | 28% baseline/68% third trimester | None | Vaginal delivery at 38 weeks under epidural | Second‐degree laceration, 500 ml blood loss | Not stated | [16] a |
| 5 | 28% baseline/64% third trimester | None | Vaginal delivery at 39 weeks with remifentanil patient‐controlled analgesia | First‐degree laceration, 600 ml blood loss | Not stated | [16] a |
| 6 | 29% baseline/38% third trimester | TXA | Caesarean delivery at 36 weeks under general anesthesia (hospitalized due to cholestasis) | 1800 ml blood loss | Packed red blood cells, FFP (IV) | [16] |
| 7 | 3 IU/dl third trimester | rFVIIa (IV) | Delivery at 38 weeks (mode of delivery not specified) | Uterine atony | Oxytocin infusion, misoprostol (oral), ergotamine, carboprost (IM), packed red blood cells; then oral TXA for 10 days | [57] |
| 8 | 5% first trimester/9% third trimester | Platelets, FFP (IV), TXA, uterotonics | Caesarean delivery at 39 weeks under general anesthesia (due to suspected foetal distress) | Uterine atony | Red cells, FFP (IV), platelets, oxytocin (IV), ergomovine, misoprostol, carbetocin (IV), transmural uterine compression sutures; FFP and platelets were continued for 5 days | [17] |
| 9 | 1.7% third trimester | Plasma‐derived FVII concentrate (IV) | Vaginal delivery at 39 weeks | 400 ml blood loss | Plasma‐derived FVII concentrate (IV) continued for 3 days | [18] |
| 10 | 3.6% baseline | None | Vaginal delivery | Massive vaginal bleeding | Blood transfusion | [40] |
| 11 | 46% second trimester | None | Caesarean delivery at 29 weeks (due to vaginal bleeding and foetal bradycardia) | Placental abruption 900 ml blood loss | Crystalloid/colloid solutions (IV); FFP and red blood cells for post‐operative anemia | [19] |
Note: Route of administration was not specified in every case.
Abbreviations: a, active; FFP, fresh frozen plasma; FVII, factor VII; IM, intramuscular; IV, intravenous; r, recombinant; TXA, tranexamic acid.
a
Postpartum hemorrhage was reported for two pregnancies in the same woman.