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Factor X Deficiency Management for Elective Cesarean Delivery in a Pregnant Patient

Unusual setting of medical care, Rare co-existance of disease or pathology

Mirna Krkovic, Andrea Koosova Gajic, Janja Tarčuković, Vlatka Sotosek, Tea Stimac, Sanja Balen, Boban Dangubic, Igor Grubjesic

Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia

Am J Case Rep 2020; 21:e920685

DOI: 10.12659/AJCR.920685

Available online: 2020-02-06

Published: 2020-03-18

BACKGROUND: Congenital factor X deficiency is a rare inherited coagulopathy. Pregnancies in women with this disorder are often associated with adverse outcomes, including miscarriage, premature labor, and hemorrhage during pregnancy and in the peripartum period. The literature on this disorder is sparse and shows a limited number of successful pregnancies in women with factor X deficiency.
CASE REPORT: In this report, we present the case of a successful pregnancy and term delivery by elective cesarean section in a 39-year-old primigravida with congenital factor X deficiency. Medical management followed the recommendations of an interdisciplinary team comprising specialists in obstetrics, anesthesia, transfusion medicine, hematology, and neonatology. This high-risk pregnancy was successfully brought to term, and a healthy male neonate was delivered by elective cesarean section at 39 weeks’ gestation. The patient’s factor X deficiency (0.19 kIU/L) was treated using 4 units of solvent-detergent-treated fresh frozen plasma (SD-FFP) 1 h before the cesarean section, leading to hemostatic levels of factor X and an uneventful intraoperative course. Postoperatively, the patient’s factor X levels were controlled daily and corrected using SD-FFP as needed, with no clinically significant blood loss.
CONCLUSIONS: SD-FFP can be used to manage congenital factor X deficiency in the peripartum period and maintain perioperative blood loss within normal limits.

Keywords: Factor X Deficiency, Pregnancy Complications, Hematologic, Pregnancy, High-Risk