Von Willebrand disease and pregnancy: A practical approach for the diagnosis and treatment

Luis D. Pacheco, Maged M. Costantine, George R. Saade, Sara Mucowski, Gary D.V. Hankins, Anthony C. Sciscione

Research output: Contribution to journalReview article

31 Scopus citations

Abstract

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 <50 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.

Original languageEnglish (US)
Pages (from-to)194-200
Number of pages7
JournalAmerican journal of obstetrics and gynecology
Volume203
Issue number3
DOIs
StatePublished - Sep 1 2010

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Keywords

  • hemorrhage
  • pregnancy
  • von Willebrand disease

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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