Von Willebrand Disease (VWD) is a relatively common bleeding disease. With VWD, the Von Willebrand Factor (VWF) is deficient or defective. VWF is a blood glycoprotein involved in hemostasis. There are several subtypes of VWD, based on the exact pathophysiology of the condition (decreased levels of VWF vs. the several ways VWF can be defective). This condition is often inherited, and common symptoms include increased menstrual flow and excessive bleeding from a cut, nosebleed, or surgery.
Levels of VWF rise 2 to 3 times in normal individuals during the second and third trimester of pregnancy, and in most patients with VWD, this also occurs such that many women with VWD do not need any treatment during pregnancy. However, many women with VWD require treatment during delivery and the few weeks following delivery when the VWF levels return to their pre-pregnancy levels.
Plasma levels of VWF fall quickly after delivery, and excessive bleeding may occur at this time. The average time of onset for postpartum hemorrhage in women with VWD is from 11 to 23 days post-delivery. Desmopressin, also known as DDAVP, can be given to increase levels of VWF. DDAVP may be required during or shortly after delivery, and the first two to four weeks after. Usually, the decision to administer DDAVP is made in consultation with the woman’s hematologist.
An anesthesia consultation should be obtained before the onset of labor to discuss options for regional anesthesia (epidural). Regional anesthesia may be considered when VWF levels are maintained at about 50 IU/dL. Knowledge of the woman’s type of VWD, activity of VWF, response to DDAVP, and past bleeding history are all useful in guiding peripartum therapy and the decision to administer regional anesthesia or not. For more information, contact us today or visit our blog.
Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!