von Willebrand's disease in pregnancy
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Management
- measure vWF-factor VIII & bleeding time at 36th week of gestation
- most patients with type 1 or 2 vWD do not bleed with normal vaginal delivery
- desmopressin for excessive bleeding except for type 2B
- if patient has severe type 1 disease & vWF &/or factor VIII levels are < 30% with bleeding times > 20 minutes at 36 weeks of gestation, treat with vWF concentrate for several days post partum
- C-section
- type 1 disease: both vWF & desmopressin may be necessary
- type 2 & 3 disease, use only vWF concentrate
More general terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998