• Benjamin Hyers, Camila Cabrera, Christopher Walsh, Anusha Reddy, Talia Strulowitz, Joshua Hamburger, Nakiyah Knibbs, Daniel Katz, Lauren Ferrara, and Yaakov Beilin.
• Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA benjamin.hyers@mountsinai.org.
• Reg Anesth Pain Med. 2024 Jun 30.

BackgroundFactor VII deficiency is considered a contraindication to neuraxial anesthesia due to the risk of an epidural hematoma.Case ReportA 32 year old G1P0 parturient with severe factor VII deficiency presented for an anesthesiology consultation at 32 weeks gestation. Initial coagulation studies were significant for an elevated INR (2.0) and a low factor VII level of 6%. After interdisciplinary discussion, it was decided that neuraxial analgesia could be offered if her coagulation studies corrected after administration of recombinant activated factor VII (rFVIIa). The patient presented at 36 weeks gestation for a rFVIIa challenge. She received 22 mcg/kg rFVIIa and coagulation studies were analyzed 20 minutes later which showed complete correction of the coagulopathy. The patient presented to the hospital at 39 weeks and 3 days for delivery, received 2 mg rFVIIa and 20 minutes later, successfully received an epidural catheter. Her INR was monitored every 3 hours during her labor course and rFVIIa was given if the INR was 1.3 or greater. She required three additional doses over 22 hours. No bleeding or thrombotic events occurred, and the patient was discharged home without complications.ConclusionThis case highlights the safe management of an epidural catheter in a parturient with severe factor VII deficiency.© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.

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