Background and Aims Intro: Von Willebrand disease (vWD) is the most common heritable bleeding disorder (1). However, there are limited reports regarding the safety of neuraxial anesthesia in the obstetric population and no definitive guidelines specifying recommended pretreatment (1).
Methods Case Information: A 25 yo G2P1 @39 weeks is admitted to L&D. The patient is 2cm dilated with SROM. The patient states she has vWD, but did not know which type, was not under the care of a hematologist, and had an epidural with her first pregnancy and ‘it went fine.’ Obstetrician was never told her patient had vWD. H/H 11.7/35.1, platelets 195. The anesthesiologist was hesitant about placing an epidural so a vWD panel was ordered. Lab results were not available until after the patient delivered. Von Willebrand activity 117, vWF 153, factor VIII 177 so overall the panel showed normal function.
Discussion Epidural analgesia is usually contraindicated in vWD (2). Despite physiological increases in von Willebrand factor antigen, factor VIII, and activity levels near normal during the third trimester in Type 1 patients, epidural anesthesia is often withheld (2,3). When von Willebrand factor (VWF) and Factor VIII levels reach 80% or more it appears to be safe for epidural placement (4).
Conclusion In patients with vWD who get pretreatment based on their type and severity can receive neuraxial anesthesia without adverse events
(1). Knowing the type and severity for vWD is critical in being able to manage these patients for neuraxial anesthesia.
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