Factor VIIa in puerperal hemorrhage with disseminated intravascular coagulation.

BACKGROUND

[corrected] Puerperal hemorrhage associated with disseminated intravascular coagulation is a life-threatening obstetric emergency. Recombinant factor VIIa is a novel hemostatic agent, but more information concerning its dosage, efficacy, and safety is required.

CASE: A primigravida developed preeclampsia complicated by disseminated intravascular coagulation and severe puerperal hemorrhage after an emergency cesarean at 35(+5) weeks of gestation. Two doses of recombinant factor VIIa controlled the hemorrhage without any thrombotic complications.

CONCLUSION

Recombinant factor VIIa should be considered when conventional methods fail to control puerperal hemorrhage complicated by disseminated intravascular coagulation. A review of 17 similar cases treated with this hemostatic agent revealed that in 76% a single dose ranging from 16.7 to 120 microg/kg controlled bleeding. Guidelines are needed to help obstetricians use recombinant factor VIIa effectively in such emergencies.