Pregnancy in special populations: challenges and solutions practical aspects of managing von Willebrand disease in pregnancy (original) (raw)

von Willebrand disease and pregnancy: a practical approach for the diagnosis and treatment

2010

Suspicion for the presence of VWD usually arises from a patient's personal history of excessive bleeding and/or a similar family history. Importantly, a family history is frequently not present because family members may be affected by the von Willebrand disease is caused by either a quantitative or qualitative defect in von Willebrand factor (VWF). Patients may have extensive mucosal bleeding (because of platelet dysfunction) and prolonged bleeding after surgery (because of factor VIII deficiency). Up to 6 different subtypes of the disease have been described, and diagnosis is based on clinical suspicion and laboratory confirmation. Accurate diagnosis is of paramount importance because therapy will vary according to the subtype. Bleeding complications during pregnancy are more frequent when levels of the von Willebrand ristocetin cofactor assay and factor VIII levels are Ͻ50 IU/dL. In such cases, therapy before any invasive procedure or delivery must be instituted. The mainstays of therapy are desmopressin and plasma concentrates that contain von Willebrand factor. Delayed postpartum hemorrhage may occur, despite adequate prophylaxis. Frequent monitoring and continued prophylaxis and/or treatment are recommended for at least 2 weeks after delivery.

Von Willebrand Disease in Pregnancy

Hematology/Oncology Clinics of North America, 2011

von Willebrand disease is the most prevalent inherited bleeding disorder, aff ecting up to 1.3% of the population. It is caused by a defect or defi ciency of the von Willebrand factor. Women with the condition may not be aware of their condition at the time of childbirth, but they are at high risk of postpartum hemorrhage even days aft er birth. In this article we briefl y review the condition and specifi c considerations for the antepartum, intrapartum, and postpartum phases. It is important for nurses who care for women during childbirth to have a keen understanding of this condition.

Pregnancy and delivery of a women with Von Willebrand disease type 3: a case report

International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Von Willebrand disease (VWB) is the most common inherited bleeding disorder, found in approximately 1% of the general population, without ethnic differences. A multidisciplinary team ensuring readiness of availability of blood and blood products, perfect intraoperative hemostatis and administration of timely Von Willebrands factor are essential to prevent complications and improve perinatal outcome.

Von Willebrand disease in pregnancy: a case report

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2021

Von Willebrand disease (VWD) is a hereditary bleeding disorder that can be severe and potentially life-threatening, particularly in pregnant women during labor and subsequently during early puerperium. There is no optimal treatment or management for this disorder. Hence, all efforts aim at early diagnosis and the focus is mainly on minimising and controlling blood loss. We described the case of a woman in the post-partum period with severe VWD, admitted in the obstetrics and gynaecology ward at Rajarajeswari Medical College and Hospital, Bangalore. Prompt diagnosis, initiation of pre-partum and intra-partum Von Willebrand factor (VWF)/clotting factor replacement therapy, vigilant post-partum monitoring of blood loss and systematic follow up will help expedite recovery and prevent adverse outcomes.

Von Willebrand Disease type 2 in pregnancy − A critical clinical association

Transfusion and Apheresis Science, 2017

Von Willebrand disease (vWD) is the most common inherited bleeding disorder. Its association with pregnancy is infrequent. Here we report three cases of vWD associated with pregnancy. The clinical features of this combination are very suggestive. However, difficulties are still encountered during the diagnosis process. The first case was diagnosed for the first time during the patient's second pregnancy despite several episodes of vaginal bleeding and suggestive clinical symptomatology. The second case was diagnosed during childhood and the patient was properly managed during this pregnancy. The third case was diagnosed at a pre-anesthesia consult, at 36 weeks gestation, before performing a cesarean section on request, despite a clinical suggestive symptomatology. All of the cases received prophylactic treatment with Haemate P ® (CSL Behring, Marburg, Germay) 24 hours before birth. No serious bleeding episodes were noticed during delivery or postpartum period. Two healthy babies were delivered from the cases Nos. 2 and 3. It is acknowledged that vaginal bleeding is common during first trimester of pregnancy. However, this study indicates that repeated bleeding episodes corroborated with a clinical suggestive symptomatology (epistaxis, heavy menstrual period, and easy bruising after minor trauma) should orient the diagnosis to vWD.

Pregnancy with Von Willebrand's Disease: A Case Report

2021

Women experience naturally occurring physiological events such as menstruation, pregnancy and childbirth that put them at risk of excessive bleeding even if they do not have a bleeding disorder. In this paper the authors review a case of pregnancy in the third trimester with a history of von Willebrand's disease where the patient does not routinely control medication and includes the latest theoretical studies in order to provide benefits in clinical practice at a later date. The patient with the initials KAE, aged 25 years with history of von Willebrand's disease since the age of 17 but was not seen frequently. On laboratory examination, a mild microcytic hypochromic anemia was found with an increase in the value of activated partial thromboplastin time (APTT) increasing to 67.1 (normal value 24 to 36). In further examination, the von Willebrand factor result was less than 2%. After the patient reaches 39 weeks of gestation it is decided to terminate the pregnancy. Pregnancy termination is performed by induction of 25 mcg misoprostol every 6 hours if preparation is optimal with intravenous desmopressin therapy and administration of cryoprecipitate transfusion if bleeding occurs. After surgery, a baby girl was born crying with active movements. Physical examination found no congenital abnormalities in the baby and the birth weight was 3540 grams, body length was 48 cm and the APGAR score was 7 in the first minute and 8 in the fifth minute.

Gynaecological and obstetric bleeding in moderate and severe von Willebrand disease

Thrombosis and haemostasis, 2011

A nation-wide cross-sectional study was initiated to assess gynaecological and obstetrical symptoms in an unselected cohort of women with moderate and severe von Willebrand disease (VWD) in the Netherlands. A total of 423 women aged ≥16 years were included. Bleeding severity was measured using the Tosetto Bleeding Score (BS). Menorrhagia, defined as occurrence of ≥2 menorrhagia symptoms, was reported by 81%. Of all VWD women, 78% received any kind of treatment for menorrhagia and 20% underwent a hysterectomy predominantly because of severe menstrual bleeding. Over half of the women reported more blood loss than can be expected with a normal delivery. In 52% of reported pregnancy losses curettage was needed because of bleeding. Mean number of live births was 1.9, which is comparable with the general Dutch population. In conclusion, women with moderate or severe VWD frequently have menorrhagia in need of treatment, and 20% of the VWD women underwent a hysterectomy. Bleeding complicati...