ABSTRACT
Factor V Leiden mutation is the most common congenital thrombophilic disorder, affecting between 5% and 8% of the Caucasian population. Pregnancy creates a state of hypercoagulability and all factors that increase the risk of thrombosis should be considered, as they may be cumulative. In recent years, the diagnosis of new allelic variants of thrombophilic states have increased the incidence of pregnant women receiving anticoagulant therapy, with the anesthetic considerations that implies. We report the case of a 33-year-old woman with heterozygous Leiden factor V mutation who was admitted with spontaneous amniorrhexis in the 38th week of gestation. She was taking low molecular weight heparin therapy. An epidural catheter was inserted to provide analgesia for labor, with all safety precautions to prevent an epidural hematoma. Epidural anesthesia is the technique of choice for obstetric labor in patients with hypercoagulability because of its effects of favoring blood flow and inhibiting clot formation.
Subject(s)
Activated Protein C Resistance/genetics , Analgesia, Epidural , Analgesia, Obstetrical/methods , Factor V/genetics , Hematoma, Epidural, Spinal/prevention & control , Pregnancy Complications, Hematologic/genetics , Thrombophilia/genetics , Activated Protein C Resistance/drug therapy , Adult , Anticoagulants/therapeutic use , Disease Susceptibility , Enoxaparin/therapeutic use , Female , Heterozygote , Humans , Infant, Newborn , Male , Medical History Taking , Pregnancy , Pregnancy Complications, Hematologic/drug therapy , Punctures/adverse effects , Risk Factors , Thrombophilia/drug therapy , Thrombosis/prevention & controlABSTRACT
La mutación del factor V Leiden, es la forma más frecuente de trastorno trombofílico congénito, afectando al 5-8% de la población caucasiana. La gestación supone, en sí misma, un estado de hipercoagulabilidad que nos debe llevar a prestar especial atención a todos aquellos factores de riesgo trombótico que puedan sumarse. En los últimos años, el diagnóstico de las nuevas variantes alélicas de los estados trombofílicos, ha incrementado la incidencia de gestantes que reciben anticoagulación con las consideraciones anestésicas que ello conlleva. Presentamos el caso de una mujer de 33 años de edad, portadora heterocigoto de una mutación en el gen del factor V Leiden, en tratamiento con heparina de bajo peso molecular, que ingresa por amniorrexis espontánea a la semana 38 de gestación. La paciente requirió analgesia para el trabajo de parto, por lo que se le colocó un catéter epidural cumpliendo los protocolos de seguridad y prevención del hematoma epidural. La anestesia epidural es la técnica de elección para analgesia del trabajo de parto, en las pacientes con hipercoagulabilidad, por sus efectos sobre la reología vascular y su efecto antitrombótico
Factor V Leiden mutation is the most common congenital thrombophilic disorder, affecting between 5% and 8% of the Caucasian population. Pregnancy creates a state of hypercoagulability and all factors that increase the risk of thrombosis should be considered, as they may be cumulative. In recent years, the diagnosis of new allelic variants of thrombophilic states have increased the incidence of pregnant women receiving anticoagulant therapy, with the anesthetic considerations that implies. We report the case of a 33-year-old woman with heterozygous Leiden factor V mutation who was admitted with spontaneous amniorrhexis in the 38th week of gestation. She was taking low molecular weight heparin therapy. An epidural catheter was inserted to provide analgesia for labor, with all safety precautions to prevent an epidural hematoma. Epidural anesthesia is the technique of choice for obstetric labor in patients with hypercoagulability because of its effects of favoring blood flow and inhibiting clot formation
