Prothrombin deficiency: a rare bleeding disorder complicated with a large retroplacental haematoma

Inherited factor II deficiency is a rare bleeding disorder which is caused by variations in factor II gene. Limited data is published on bleeding risk and management of these patients during pregnancy. According to available data antepartum haemorrhage (APH), postpartum haemorrhage (PPH) and pregnancy loss are common compli-cations in pregnant females with factor II deficiency. This 26 year old woman with prolonged PT and APTT was in her first pregnancy. She had a history of spontaneous mucocutaneous bleeding and menorrhagia. Her factor II level done at 12 weeks of gestation was 3.7%. She was started on prothrombin complex concentrate (PCC) 1000 IU once per week after confirmation of the diagnosis. Despite PCC prophylaxis she developed a large retroplacental haematoma and ended up in a second trimester miscarriage. This was managed with increased doses of PCC, red cell transfusions and tranexamic acid infusions. Management of pregnancy in factor II deficiency requires a multi disciplinary approach. In resource poor settings outcome of pregnancies is affected by limitations of laboratory facilities for factor level monitoring and lack of psychosocial support.