EP121 Epidural in a parturient with haemophilia B carrier status – a case report

<h3>Background and Aims</h3> Female haemophilia B carriers can present with a heterogeneous bleeding phenotype due to variable lyonisation of one of the pair of X chromosomes. Published obstetric and haemophilia society guidelines recommend Factor IX (FIX) levels above 50% for neuraxial procedures and delivery. <h3>Methods</h3> We report the management of a 24-year old nulliparous woman with haemophilia B carrier status who received epidural labour analgesia, and who required a replacement of her epidural catheter during her labour. The third-trimester, pre-procedural Factor IX level was 128%. She subsequently underwent a Caesarean section under regional anaesthesia with epidural top-up. The epidural catheter was removed immediately post-surgery. No haematoma or post-procedure complications were observed. <h3>Results</h3> Epidural for labour analgesia and surgical anaesthesia is a viable, versatile option for female haemophilia B carriers. Neuraxial techniques avoid the risks related to general anaesthesia should a Caesarean section be indicated, especially in the context of the high risks associated with assisted instrumented vaginal delivery of an infant with unknown haemophilia status. A multi-disciplinary (obstetrician, anaesthetist, haematologist), individualised approach to the delivery plan is critical in the management of these patients. <h3>Conclusions</h3> Female haemophilia carriers may be at increased risk of peri-partum bleeding if their FIX levels are low. Epidural placement can be performed for female carriers of haemophilia B if clotting factors are normalised and can be effective for both labour analgesia and anaesthesia for Caesarean section.