Summary
Background. Recombinant factor VIIa has been shown to induce hemostasis in various surgical situations in non-hemophilic patients. We describe a case of serious intraoperative bleeding that occurred during cesarean section for quadruplet delivery. Case report. A 30-yr-old primagravida with quadruplets was scheduled for cesarean section under spinal anesthesia in the 30 ^th week of pregnancy, because of increased blood pressure, thrombocytopenia and developing renal insufficiency. After 10 minutes of uncomplicated surgery, four live premature infants were born and transferred to the neonatal unit. During closure of the uterus, serious bleeding occurred, with blood loss of 2000 cc and hypotension. Since the haemorrhage could not be stopped using conventional methods (uterovaginal packing, methergine, or oxytocin), 2.4 mg of recombinant factor VIIa (NovoSeven, Novo Nordisk A/S, Bagsverd, Denmark) was given intravenously, resulting in an immediate reduction in bleeding. Four hours after surgery the patient began bleeding again and another dose of rFVIIa was given, this time without visible effect, probably due to uterine muscle atonia. Emergency hysterectomy was performed, complicated by severe intraoperative ovarian haemorrhage that was controlled by administration of another dose of rFVIIa. The quadruplets survived and were discharged home at 40 and 76 weeks of age. Conclusion. The case report describes the successful use of rFVIIa to control obstetric bleeding in a young mother of four. Despite very few reports about the use of rFVIIa in such situations, it may be useful in life-threatening situations, when conventional methods fail.