This study by Schjoldager et al. (AJOG, 2017) sought to determine if treating the placenta site with recombinant factor VII (rFVIIa) after removal of placenta following placenta previa decreases PPH with affecting intravascular coagulation.
5 cases booked for cesarean section for placenta previa were prospectively evaluated.
rFVIIa (1 mg/246 ml) was applied to the placental bed via soaked swab following delivery and placental removal. The surgeon repeated the procedure if the first application was not effective. Hemoglobin concentration, platelet count, INR, APTT, fibrinogen and factor VII were tested in peripheral blood before and after removal of the placenta. These blood variables were also tested in women undergoing planned C-sections without previa. In all of the cases median blood loss was 490 ml (range 300-800). No negative effects were seen from the rFVIIa, and it did not enter the circulation. No changes in coagulation parameters were found.
Topical application of recombinant activated factor VII during cesarean section for placenta previa
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