Regional blocks like spinal, epidural and combined spinal epidural (CSE) are relatively contraindicated in individuals with bleeding disorders. Consequently pregnant women with severe factor XI (FXI) deficiency are often denied this option during labour and caesarean section. We describe three women with severe FXI deficiency in whom regional block was performed with low-dose recombinant factor VIIa (rFVIIa) for their operative procedures during delivery. All women achieved haemostasis and had uncomplicated regional block, delivery and surgical procedures. The point of care device--rotational thromboelastometry (ROTEM) was used to monitor the patients' coagulation and determine the dose of rFVIIa to achieve in vitro haemostasis in these women that was then subsequently used in vivo. Low-dose rFVIIa seems to be effective and safe in the management of delivery and enables provision of regional blocks in women with severe FXI deficiency.

Introduction ROTEM is a point of care testing (POCT) device that provides rapid specific coagulation pathway assessment. The use of ROTEM is well established in liver and cardiac surgery, but not as yet in an Obstetric setting. Previous studies have reported ROTEM values in pregnancy and postpartum but not in active labour. Methods Ethical approval was obtained. Healthy labouring women at term were recruited at the point of requiring blood tests or intravenous access. Exclusion criteria were pre-eclampsia, liver disease, haematological disorders and taking of coagulation altering drugs. On the blood sample we performed ROTEM analysis, including EXTEM, INTEM and FIBTEM and routine laboratory analysis (Clauss method) for fibrinogen. Results At the time of submission, data sets were complete on 30 women (table 1). Abstract PMM.81 Table 1 CT (s) CFT (sec) MCF (mm) CA15 (mm) EXTEM 52(48–55) 65(59–71) 73(72–76) INTEM 151(134–159) 53(49–59) 73(71–76) FIBTEM – – 23(20.3–27) ROTEM values are given as median (inter-quartile range). CT, clotting time; CFT, clot formation time; MCF, maximum clot formation; CA15, clot amplitude at 15 min. Discussion POCT is able to provide results much earlier than equivalent routine laboratory assays and the use of ROTEM is increasing in many areas. This preliminary data represents the first time a normal range of ROTEM values has been described in labouring women. As we gain greater understanding of the values in normal and abnormal labour, it is envisaged that ROTEM will become key to effectively managing blood product replacement in major Obstetric haemorrhage.