Von Willebrand Disease and Pregnancy: Management Protocol From Labor to the Postpartum Period.

ABSTRACT

Von Willebrand disease (VWD) is a hemostatic disorder characterized by a quantitative or qualitative deficiency of the Von Willebrand factor (VWF). It affects males and females equally. This pathology has more severe clinical manifestations in females of reproductive age, with a mean age of diagnosis at 19 years. In the pregnant patient, Von Willebrand disease poses an increased risk of complications during labor or the postpartum period, attributed to a higher likelihood of experiencing postpartum hemorrhage and its consequential complications arising from transfusion support and multiorgan injury due to tissue hypoperfusion. We present the case of a 25-year-old G3P2V2A1 patient with a preexisting diagnosis of Von Willebrand disease prior to gestation. The institutional protocol for managing this condition involved the administration of Von Willebrand factor and factor VIII (FVIII) during vaginal delivery and the postpartum period. This resulted in the effective control of perinatal and postpartum bleeding, with an elevation in Von Willebrand factor levels, thereby avoiding the need for blood transfusions and signs of secondary hypoperfusion. This case underscores the significance of specialized management for Von Willebrand disease during pregnancy and childbirth, emphasizing adherence to institutional protocols involving specific hemostatic factors. The collaborative efforts of a multidisciplinary team, including hematologists, obstetricians, and other healthcare professionals, are crucial for the comprehensive care of females with this condition during the perinatal period.