title: Management of Labour and Delivery in a Patient With Acquired Factor VII Deficiency With Inhibitor: A Case Report.
abstract: BACKGROUND
  Acquired factor VII (FVII) deficiency with inhibitor increases the risk of hemorrhage during pregnancy. However, there are no published reports guiding its management in the peripartum period.
  
  
  METHODS
  A 24-year-old woman with inhibitory antibodies to FVII delivered at 34 weeks of gestation. The patient was administered recombinant factor VIIa (rFVIIa) and tranexamic acid. There were no bleeding-related complications; however, the FVII level was supratherapeutic. The patient returned during a second pregnancy. A reduced dose of rFVIIa was administered. The delivery was complicated by postpartum hemorrhage, which resolved with the addition of uterotonic agents.
  
  
  CONCLUSIONS
  Recombinant FVIIa and tranexamic acid offer an effective peripartum treatment in women with inhibitory antibody to FVII. Further research should delineate the optimal time of administration.
authors.affiliation: Department of Obstetrics and Gynecology, Dalhousie University, Halifax NS.
authors.forename: Anca
authors.initials: A
authors.lastname: Matei
authors.affiliation: Department of Hematology, Saint John Regional Hospital, Saint John NB.
authors.forename: Sean
authors.initials: S
authors.lastname: Dolan
authors.affiliation: Department of Obstetrics and Gynecology, Saint John Regional Hospital, Saint John NB.
authors.forename: James
authors.initials: J
authors.lastname: Andrews
authors.affiliation: Department of Hematology, Université de Montréal, Montreal QC.
authors.forename: Georges-Étienne
authors.initials: GÉ
authors.lastname: Rivard
mesh_terms: D000328:Adult; D005168:Factor VII Deficiency / Q000188:drug therapy*; D015942:Factor VIIa / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006473:Postpartum Hemorrhage / Q000188:drug therapy; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy*; D047928:Premature Birth; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D006490:Hemostatics; D011994:Recombinant Proteins; D014148:Tranexamic Acid; C103587:recombinant FVIIa; D015942:Factor VIIa
keywords: Factor VII deficiency; coagulopathy; postpartum hemorrhage; pregnancy; recombinant factor VIIa