title: Successful Pregnancy in a Patient with Combined Deficiency of Factor V and Factor VIII.
abstract: Inherited combined factor V and factor VIII deficiency (F5F8D) is autosomal recessive transmission disorder. Epistaxis, postsurgical bleeding, and menorrhagia are the most common symptoms. The risk of miscarriage and placental abruption is consequent. We report a case of successful pregnancy in a patient with F5F8D. 20-year-old woman, born of consanguineous parents, third gestate, first parity, two miscarriages, admitted for child birth of a spontaneous pregnancy estimated at 38 weeks and was diagnosed with F5F8D. At admission, patient was hemodynamically stable, with good obstetric conditions. The biologic results showed low levels of PT (52%), factor V (7%), and factor VIII (5%), and the activated partial thromboplastin time was prolonged (68,6%). Parturient was admitted in intensive care unit, maternal and fetal monitoring was performed. Fresh frozen plasma (FFP) and factor VIII concentrates were perfused at the induction of labor. Analgesia used fentanyl titration. The delivery gave birth to a newborn male, with Apgar 10/10 and 3000 g. The puerperium was simple without any important bleeding. Laboratory tests for the newborn were acceptable. Little literature is available on this subject and there are no guidelines available concerning pregnancy; we chose to prescribe a combination of factor VIII concentrate and FFP in pre-, per- and postpartum. The same protocol was successfully used in a patient before dental extraction and prostatectomy. Vaginal delivery is possible, as our case. Management by multidisciplinary team is recommended.
authors.affiliation: Department of Anesthesia and Critical Care, University Hospital Mohammed VI, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco.
authors.forename: Ahmed Ghassan
authors.initials: AG
authors.lastname: El Adib
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Mohammed VI, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco.
authors.forename: Farah
authors.initials: F
authors.lastname: Majdi
authors.affiliation: Department of Anesthesia and Critical Care, University Hospital Mohammed VI, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco.
authors.forename: Mohamed Othmane
authors.initials: MO
authors.lastname: Dilai
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Mohammed VI, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco.
authors.forename: Hamid
authors.initials: H
authors.lastname: Asmouki
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Mohammed VI, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco.
authors.forename: Ahlam
authors.initials: A
authors.lastname: Bassir
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Mohammed VI, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco.
authors.forename: Karam
authors.initials: K
authors.lastname: Harou
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Mohammed VI, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco.
authors.forename: Abderraouf
authors.initials: A
authors.lastname: Soumani
authors.affiliation: Department of Anesthesia and Critical Care, University Hospital Mohammed VI, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco.
authors.forename: Said
authors.initials: S
authors.lastname: Younous
authors.affiliation: Department of Hematology and Oncology, University Hospital Mohammed VI, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco.
authors.forename: Lahoucine
authors.initials: L
authors.lastname: Mahmal