帝王切開を脊髄くも膜下麻酔で2度行った血友病A確定保因者の麻酔管理

Hemophilia A carriers are usually asymptomatic and their risk of bleeding when giving birth is not necessarily high, since the level of coagulation factor VIII (FVIII) increases during the perinatal period.　However, for mothers whose FVIII activity remains low, bleeding risk is increased and a Caesarean section is required when the fetus is a male. We report here anesthetic management for a hemophilia A carrier who underwent a selective Caesarean section procedure on two separate occasions during birth of male infants.　The level of FVIII was noted to be increased during the perinatal period, thus management by spinal subarachnoid anesthesia alone was used for the first childbirth and combined spinal-epidural anesthesia for the second.　FVIII remained within a normal range throughout both procedures, and no complications occurred in either the mother or the newborns.