title: Combined deficiency of factors II, VII, IX, and X (Borgschulte-Grigsby deficiency) in pregnancy.
abstract: BACKGROUND
  Combined deficiency of vitamin K-dependent coagulation factors (II, VII, IX, X) is an uncommon challenge for the expectant gravida.
  
  
  METHODS
  A 34-year-old primigravida had congenital combined deficiency of factors II, VII, IX, and X that were incompletely sensitive to vitamin K. She had an altered form of vitamin K-dependent factors that retained immunologic activity but lacked coagulant activity and the normal complement of gamma-carboxyglutamic acid residues. She required vitamin K supplementation throughout her life. After an uneventful pregnancy she had postpartum hemorrhage resulting from an episiotomy. Fresh frozen plasma was administered to achieve hemostasis. The remainder of her postpartum course was normal.
  
  
  CONCLUSIONS
  Combined congenital deficiency of factors II, VII, IX, and X can be managed in pregnancy with the use of vitamin K and fresh frozen plasma.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 214 MacNider Building, CB #7516, Chapel Hill, NC 27599-7516, USA. mcmahon@med.unc.edu
authors.forename: M J
authors.initials: MJ
authors.lastname: McMahon
authors.forename: A H
authors.initials: AH
authors.lastname: James
mesh_terms: D000328:Adult; D001803:Blood Transfusion; D020147:Coagulation Protein Disorders / Q000628:therapy*; D005168:Factor VII Deficiency / Q000628:therapy; D005171:Factor X Deficiency / Q000628:therapy; D005260:Female; D002836:Hemophilia B / Q000628:therapy; D006801:Humans; D007020:Hypoprothrombinemias / Q000628:therapy; D010949:Plasma; D011181:Postnatal Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011295:Prenatal Care