Prophylaxis of peripartum haemorrhage using recombinant factor VIIa (rfVIIa) in pregnant women with congenital factor VII deficiency: A case report and literature review

Diagnosis and treatment discussion of congenital factor VII deficiency in pregnancy: A case report

“…After further analysis of the reported cases, the most common conclusion is that the FVII activity level, FVII genotype, coagulation test, and bleeding history could not predict the bleeding risk of patients with FVIID[ 14 ]. In preliminary studies, some patients with FVII activity lower than 8% showed mild symptoms or no symptoms; 12 patients with no previous bleeding history and 44% FVII activity had delayed intracranial hemorrhage[ 5 ].…”

“…The treatment plan for pregnant women with congenital FVIID largely depends on the infusion of fresh frozen plasma, prothrombin complex concentrate, activated prothrombin complex concentrate, plasma-derived FVII concentrate, rFVIIa, etc. rFVIIa can be combined with tissue factor to stop bleeding at specific sites, with a slight risk of thrombosis (< 0.4%) and virus transmission[ 14 ]. Currently, rFVIIa is the preferred alternative treatment[ 8 ].…”

“…Mumford et al [ 20 ] suggested that the use of rFVIIa (15-30 μg/kg, every 4 h) should be considered for prevention of at least 3 d in late pregnancy for pregnant women with FVII < 20% (with a history of abnormal bleeding or cesarean section). Loddo et al [ 14 ] deemed that pregnant women with FVII activity level lower than 10%-20% are at high risk of postpartum hemorrhage, especially for patients with a history of abnormal bleeding and are more likely to need rFVIIa prevention and treatment. The recommended dosage for treatment of congenital FVIID pregnant women during delivery is 15-30 μg/kg every 4-6 h, and the increasing dosage depends on the bleeding situation.…”

“…Loddo et al [ 14 ] described a 35-year-old woman with coagulation FVIID who received an intravenous dose of 20 μg/kg rFVIIa at cervix full opening at 40 wk of gestation, followed by the same dose 4 h later. The woman had an initial FVII activity of 18% (normal range 60%-150%).…”

“…A low correlation was found between the level of FVII activity and the risk of bleeding. FVII genotype, coagulation test, and bleeding history cannot predict the risk of bleeding in patients with FVIID[ 14 ]. Therefore, predicting the risk of bleeding and determining the corresponding treatment in clinical practice is difficult.…”