Safe Neuraxial Anesthesia in a Pregnant Patient with Congenital Factor VII Deficiency: A Case Report

Abstract

Congenital factor VII deficiency is a rare autosomal recessive bleeding disorder with a variable clinical phenotype, ranging from asymptomatic individuals to those with severe hemorrhage. The peripartum management of such patients, especially regarding the use of neuraxial anesthesia, remains controversial due to the absence of evidence-based guidelines or expert consensus. We present the case of a 31-year-old primiparous woman with an incidental diagnosis of mild heterozygous factor VII deficiency. Several months before conception, she had revealed a significantly prolonged prothrombin time. Serial factor measurements during pregnancy revealed a physiological rise in factor VII levels. Following a multidisciplinary assessment and patient-informed decision-making, she underwent a successful vaginal delivery with uneventful epidural analgesia. No factor replacement or administration of procoagulant agents was required. This case underscores the importance of individualized management strategies in rare bleeding disorders and suggests that neuraxial anesthesia may be safely considered in select patients with factor VII deficiency.