Anesthetic Management of a Parturient Posted for Cesarean Section with Congenital Factor VII Deficiency

Abstract

Congenital factor VII (FVII) deficiency, also known as hypoproconvertinemia, is a rare autosomal recessive bleeding disorder that affects the extrinsic coagulation pathway. This case report describes the peripartum anesthetic and hematological management of a 31-year-old female, a primigravida, who presented for delivery with a known, moderate-to-severe FVII deficiency. The primary management challenge involved carefully balancing the risk of massive postpartum hemorrhage against the thrombotic risks associated with FVII replacement therapy. The patient was successfully managed through a multidisciplinary team approach and the pre-emptive administration of recombinant activated FVII. Monitoring, including thromboelastography (TEG), was utilized, which, despite the known limitations of Kaolin TEG in isolated FVII deficiency, helped guide management. An uneventful Cesarean section was performed under general anesthesia. This case highlights the critical importance of meticulous, multidisciplinary collaboration in managing this high-risk obstetric population.