von Willebrand's disease in pregnancy

Management: 1) measure vWF-factor VIII & bleeding time at 36th week of gestation 2) most patients with type 1 or 2 vWD do not bleed with normal vaginal delivery 3) desmopressin for excessive bleeding except for type 2B 4) 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 5) C-section a) type 1 disease: both vWF & desmopressin may be necessary b) type 2 & 3 disease, use only vWF concentrate

References

Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998