Abstract
Objective
Higher rates of postpartum hemorrhage (PPH) have been reported for women with von
Willebrand disease (VWD). Comprehensive multidisciplinary care reduces these rates;
thus PPH may not be secondary to VWD.
Methods
We conducted a retrospective review for the period of 2009–2018, including all VWD
pregnancies at 2 tertiary care academic hospitals to determine rates, etiology, and
timing of PPH.
Results
A total of 63 women with 80 pregnancies were included. Three women had twin pregnancies.
Sixty-six pregnancies (82.5%) involved type 1 VWD; 4 (5.0%), type 2 (unclear subtype);
3 (3.8%) type 2A; 3 (3.8%) type 2B; and 2 (2.5%), type 2M. Median age of patients
was 32.9 years (range 19–43 y). Most patients were blood type O (65%), and 33 of 80
pregnancies (41.3%) were nulliparous. The mean bleeding assessment score was 8 (range
0–16). Thirty-seven pregnancies (46.3%) received prophylactic hemostatic treatment
prior to delivery. Seventy-four percent of pregnancies were delivered vaginally, and
88% received epidural anaesthesia. The majority of pregnancies (78.8%) had von Willebrand
factor (VWF) levels assessed during the third trimester, with most (71.3%) achieving
VWF levels above 1.00 IU/mL. Four pregnancies (5.2%) were complicated by primary PPH;
uterine atony in 2 and placenta previa in 1. Delayed postpartum bleeding occurred
in 5 pregnancies (6.3%).
Conclusion
Multidisciplinary care of pregnancies with VWD improves outcomes. Rates of primary
and delayed PPH in this study are lower than previously described and are similar
to those of women without VWD. In women with VWD, uterine etiologies for primary PPH
need to be considered, in a manner similar to the assessment of women without VWD,
to ensure hemostasis is achieved.
Résumé
Objectif
On rapporte une augmentation du taux d’hémorragie post-partum (HPP) chez les femmes
atteintes de la maladie de von Willebrand (MVW). Comme les soins multidisciplinaires
intégrés réduisent le taux d’incidence, l’HPP pourrait ne pas être secondaire à la
MVW.
Méthodologie
Nous avons effectué un examen rétrospectif de toutes les grossesses avec MVW pour
la période de 2009 à 2018 dans deux hôpitaux universitaires de soins tertiaires afin
de déterminer le taux d’incidence, l’étiologie et le moment de l’HPP.
Résultats
L’étude inclut les données de 63 femmes, pour un total de 80 grossesses. Trois femmes
ont eu une grossesse gémellaire. La distribution des grossesses selon le type de MVW
va comme suit : 66 (82,5 %) de type 1; 4 (5,0 %) de type 2 (sous-type incertain);
3 (3,8 %) de type 2A; 3 (3,8 %) de type 2B; et 2 (2,5 %) de type 2M. L’âge médian
des patientes était de 32,9 ans (intervalle : 19–43 ans). La plupart des patientes
étaient du groupe sanguin O (65 %), et 33 des 80 grossesses (41,3 %) étaient chez
des patientes nullipares. Le score moyen de l’évaluation des saignements était de
8 (plage : 0–16). Un traitement hémostatique a été donné en prophylaxie avant l’accouchement
dans 37 grossesses (46,3 %). L’accouchement s’est fait par voie vaginale dans 74 %
des grossesses, et 88 % ont impliqué une anesthésie péridurale. La majorité des grossesses
(78,8 %) ont eu un dosage du facteur de von Willebrand (FVW) au troisième trimestre;
la plupart (71,3 %) ont eu une concentration du FVW supérieure à 1,00 UI/ml. L’HPP
primaire a été en cause dans 4 grossesses (5,2 %); l’atonie utérine, dans 2; et le
placenta prævia, dans 1. Des saignements post-partum retardés se sont manifestés dans
5 grossesses (6,3 %).
Conclusion
La prise en charge multidisciplinaire des grossesses associées à la MVW améliore les
issues. Les taux d’HPP primaire et retardée dans cette étude sont inférieurs à ceux
décrits précédemment et sont comparables à ceux observés chez les femmes non atteintes
de la MVW. Chez les femmes atteintes de la MVW, il faut envisager les étiologies utérines
pour l’HPP primaire, de façon similaire à l’évaluation chez les femmes non atteintes,
afin d’obtenir l’hémostase.
Keywords
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Article info
Publication history
Published online: May 12, 2022
Accepted:
March 30,
2022
Received:
January 17,
2022
Footnotes
Disclosures: Nadine Shehata received speaker fees from Ferring International for a session on coagulopathy, transfusion, and pregnancy during COVID-19. The other authors have no relevant financial or nonfinancial interests to disclose.
Each author has indicated they meet the journal’s requirements for authorship.
Identification
Copyright
© 2022 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
