EP134 Epidural anesthesia without hemostatic prophylaxis in a parturient with mild factor VII deficiency: a case report

<h3>Background and Aims</h3> Factor VII (FVII) deficiency is a rare autosomal recessive bleeding disorder, with an estimated incidence of 1:500,000 to 1:1,000,000 live births. Severity is categorized based on FVII activity levels, yet clinical bleeding symptoms often show poor correlation with serum levels. Pregnancy presents a unique hemostatic challenge due to physiological hypercoagulability in the third trimester. Data on the safety of loco-regional anesthesia in FVII-deficient patients during labor remains limited. We present the first case of a parturient with mild FVII deficiency without any hemostatic correction treatment, who received epidural anesthesia for her labor. <h3>Methods</h3> We report the case of a 40-year-old primigravida with mild FVII deficiency (FVII activity 39%, INR 1.4), diagnosed during pregnancy. The patient had no prior bleeding episodes, surgical history, or family history of bleeding disorders. Hemostatic evaluation (HEMOSTOP) was negative. After multidisciplinary consultation involving hematologist, OB and anesthesiology team - a plan was made for vaginal delivery with an epidural analgesia, without prophylactic hemostatic therapy. <h3>Results</h3> At 40 weeks gestation, the patient underwent spontaneous vaginal delivery under epidural anesthesia. No peri- or postpartum bleeding complications occurred. Estimated blood loss was 150 mL, and no factor replacement or additional hemostatic interventions were required. <h3>Conclusions</h3> This case supports emerging evidence that, in asymptomatic patients with mild FVII deficiency, vaginal delivery and epidural anesthesia may be safely performed without prophylactic factor replacement. Multidisciplinary assessment remains critical, and further data are needed to inform clinical guidelines in this rare patient population.