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Background and Aims von Willebrand’s disease (vWD) is an autosomal dominant condition resulting in deficiency in von Willebrand Factor (vWF) either quantitatively or qualitatively. Parturients with vWD are at increased risk of peripartum haemorrhage, and neuraxial anaesthetic may cause increased risk of spinal or epidural haematoma formation.

Methods A 30-year-old primigravida with vWD 2A and scoliosis presented at 39+3/52 for induction of labour. She had been seen by Haematology at 11 weeks to determine suitability for epidural, with potential need for factor VIII transfusion should factor levels not rise sufficiently in labour. vWF Antigen (vWFAg) levels rose to 113 in week 35 and vWF Activity levels increased to 98 at 35 weeks. Haematologist advised that no prophylaxis was required for epidural, but advised to start IV tranexamic acid when in labour until 1 week postnatally. The patient was counselled regarding potential difficult epidural, with need for repeated attempts hence increased risk of bleeding in view of her background of scoliosis. Continuous spinal-epidural was performed uneventfully. Epidural worked well and was removed 1h post delivery with no complications. Estimated blood loss during delivery was 250ml. Factor VIII, vWFAg and vWF activity levels checked on day 1 post-delivery were acceptable. The patient was discharged well.

Conclusions Epidural haematoma is a rare but potentially devastating complication post-epidural. vWD patients are at increased risk due to their bleeding diathesis. Close follow up and multidisciplinary discussion between patient, anaesthetist and haematologist is required prior to proceeding with neuraxial. Factors increasing difficulty of epidural e.g. scoliosis also need to be considered.