PDF(Pubmed)
Abstract：
UNASSIGNED: Factor (F)XI deficiency is a rare bleeding disorder with a poor correlation between bleeding tendency and FXI level. Management of pregnant women with FXI deficiency is not clearly established, especially regarding neuraxial analgesia (NA).
UNASSIGNED: A retrospective multicenter observational study was conducted in French hemostasis centers on pregnant women with FXI of <60 IU/dL.
UNASSIGNED: Data to report were (i) FXI levels before pregnancy and at time of delivery, (ii) type of NA and delivery management modalities, and (iii) possible complications related to NA and bleeding complications.
UNASSIGNED: Three hundred fourteen pregnancies in patients with FXI deficiency of <60 IU/dL were reported (from 20 centers); among them, 199 NA procedures have been completed (137 epidurals and 61 spinals, 1 had both). The period of childbirth was mostly from 2014 to 2020 (281/314; 89.5%). Congenital FXI deficiency was established with certainty by investigators in 32.8% patients (n = 103). Previous bleedings were described in 20.4% of the patients (64/314; 45.3% cutaneous, 31.3% gynecologic, and 15.6% postsurgical). Thirteen deliveries had an NA procedure with FXI of <30 IU/dL, 42 with FXI of 30-40 IU/dL, and 118 with FXI of 40-60 IU/dL. Median FXI levels at delivery in the epidural and spinal groups were not significantly different but were significantly lower in the group without NA by medical staff contraindications. There were no complications related to NA. A 17.5% postpartum hemorrhage or excessive postpartum bleeding incidence was reported, which is consistent with previous data.
UNASSIGNED: Our data support the use of a 30 IU/dL FXI threshold for NA, as suggested by the French proposals published in August 2023.
UNASSIGNED: A retrospective multicenter observational study was conducted in French hemostasis centers on pregnant women with FXI of <60 IU/dL.
UNASSIGNED: Data to report were (i) FXI levels before pregnancy and at time of delivery, (ii) type of NA and delivery management modalities, and (iii) possible complications related to NA and bleeding complications.
UNASSIGNED: Three hundred fourteen pregnancies in patients with FXI deficiency of <60 IU/dL were reported (from 20 centers); among them, 199 NA procedures have been completed (137 epidurals and 61 spinals, 1 had both). The period of childbirth was mostly from 2014 to 2020 (281/314; 89.5%). Congenital FXI deficiency was established with certainty by investigators in 32.8% patients (n = 103). Previous bleedings were described in 20.4% of the patients (64/314; 45.3% cutaneous, 31.3% gynecologic, and 15.6% postsurgical). Thirteen deliveries had an NA procedure with FXI of <30 IU/dL, 42 with FXI of 30-40 IU/dL, and 118 with FXI of 40-60 IU/dL. Median FXI levels at delivery in the epidural and spinal groups were not significantly different but were significantly lower in the group without NA by medical staff contraindications. There were no complications related to NA. A 17.5% postpartum hemorrhage or excessive postpartum bleeding incidence was reported, which is consistent with previous data.
UNASSIGNED: Our data support the use of a 30 IU/dL FXI threshold for NA, as suggested by the French proposals published in August 2023.
摘要：
■因子（F）XI缺乏是一种罕见的出血性疾病，出血倾向与FXI水平之间的相关性较差。对FXI缺乏症孕妇的管理尚未明确确定，特别是关于神经轴镇痛（NA）。
■在法国止血中心对FXI<60IU/dL的孕妇进行了一项回顾性多中心观察性研究。
■报告的数据是（i）怀孕前和分娩时的FXI水平，(二)NA类型和交付管理模式，和(iii)与NA和出血并发症相关的可能并发症。
■报告了<60IU/dL的FXI缺乏症患者（来自20个中心）的三百十四个妊娠；其中，已完成199个NA程序（137个硬膜外和61个脊髓，1两者都有）。分娩时间主要为2014年至2020年（281/314;89.5％）。研究者在32.8%的患者（n=103）中确定了先天性FXI缺乏症。20.4%的患者描述了先前的出血(64/314;45.3%皮肤，31.3％妇科，术后15.6%)。13次分娩的NA程序FXI<30IU/dL，42，FXI为30-40IU/dL，和118，FXI为40-60IU/dL。硬膜外和脊柱组分娩时的FXI中位数水平没有显着差异，但根据医务人员的禁忌症，无NA组的FXI中位数水平显着降低。无与NA相关的并发症。报告了17.5％的产后出血或产后出血过多的发生率，这与以前的数据一致。
■我们的数据支持对NA使用30IU/dLFXI阈值，正如2023年8月公布的法国提案所建议的那样。
■在法国止血中心对FXI<60IU/dL的孕妇进行了一项回顾性多中心观察性研究。
■报告的数据是（i）怀孕前和分娩时的FXI水平，(二)NA类型和交付管理模式，和(iii)与NA和出血并发症相关的可能并发症。
■报告了<60IU/dL的FXI缺乏症患者（来自20个中心）的三百十四个妊娠；其中，已完成199个NA程序（137个硬膜外和61个脊髓，1两者都有）。分娩时间主要为2014年至2020年（281/314;89.5％）。研究者在32.8%的患者（n=103）中确定了先天性FXI缺乏症。20.4%的患者描述了先前的出血(64/314;45.3%皮肤，31.3％妇科，术后15.6%)。13次分娩的NA程序FXI<30IU/dL，42，FXI为30-40IU/dL，和118，FXI为40-60IU/dL。硬膜外和脊柱组分娩时的FXI中位数水平没有显着差异，但根据医务人员的禁忌症，无NA组的FXI中位数水平显着降低。无与NA相关的并发症。报告了17.5％的产后出血或产后出血过多的发生率，这与以前的数据一致。
■我们的数据支持对NA使用30IU/dLFXI阈值，正如2023年8月公布的法国提案所建议的那样。
