Abstract
We report an experience of perioperative management of a 33-year-old woman with congenital hypofibrinogenemia, for myomectomy initially and cesarean section later. Her preoperative plasma fibrinogen level was 134 mg/dL, so supplementary fibrinogen therapy was given to increase it up to 173 mg/dL, effective for myomectomy.
Neuraxial anesthesia is generally contraindicated in patients who have coagulopathy because of the risk of epidural/spinal hematoma. To perform myomectomy, we performed transversus abdominis plane block combined with general anesthesia. No abnormal bleeding, failure of wound-healing, or failure of sutures were observed perioperatively.
After explaining the benefits and risks of spinal anesthesia, we obtained informed consent from our patient to perform spinal anesthesia for cesarean section, although there is no agreement on the appropriate minimal level of the plasma fibrinogen in this setting. In Cesarean section, we gave spinal anesthesia at 280 mg/dL of fibrinogen level and we had no complications perioperatively. We believe that spinal anesthesia can be safely performed in patients with congenital hypofibrinogenemia who are going to undergo surgical treatment as long as blood coagulation status is adequately assessed and prophylactic treatment is maintained.
