A single‐centre study of management of pregnant women with von Willebrand disease

Xu, Zhuang; Dargaud, Yesim; Chamouard, V.; Quellec, Sandra Le; Lienhart, Anne; Meunier, Sandrine; Rugeri, Lucia

doi:10.1111/hae.13653

Cited by 5 publications

(16 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although it intuitively makes sense to check third trimester levels to decide on the type and intensity of prophylaxis at the time of active labor, it is still not clear that monitoring third trimester levels will fully reduce PPH in women with VWD. For example, in a recent single‐center retrospective study of 86 pregnancies in 55 women with VWD, all patients underwent third trimester monitoring, yet the incidence of primary PPH was 6.9%, similar to our findings in a population with much lower rates of screening . One cause of high rates of PPH despite third trimester monitoring may be current guidelines that recommend VWF replacement to > 50%, although recent studies suggest we are undertreating women with VWD with this approach and should rather be aiming closer to the levels of 150% to 200% that occur postpartum in the general population …”

Section: Resultssupporting

confidence: 84%

“…In retrospective studies, the incidence of PPH was reported as 1% to 3% in the general population, although in a recent prospective study 4.8% of women lost > 2000 mL of blood after childbirth . Prior studies indicate an incidence of PPH of 6% to 37% in women with VWD . There is scarce literature regarding the risk of HMB after childbirth because of resumption of menses in women with bleeding disorders.…”

Section: Resultsmentioning

confidence: 99%

“…13 Prior studies indicate an incidence of PPH of 6% to 37% in women with VWD. 2,12,[14][15][16] There is scarce literature regarding the risk of HMB after childbirth because of resumption of menses in women with bleeding disorders. In this study, we found that approximately 5% of patients had a diagnosis of HMB within the first 3 months after delivery.…”

Section: After Application Of Our Inclusion and Exclusion Criteria 2238mentioning

confidence: 99%

“…For example, in a recent single-center retrospective study of 86 pregnancies in 55 women with VWD, all patients underwent third trimester monitoring, yet the incidence of primary PPH was 6.9%, similar to our findings in a population with much lower rates of screening. 16 One cause of high rates of PPH despite third trimester monitoring may be current guidelines that recommend VWF replacement to > 50%, 5,18 although recent studies suggest we are undertreating women with VWD with this approach and should rather be aiming closer to the levels of 150% to 200% that occur postpartum in the general population. 11,[18][19][20] In conclusion, we found that third-trimester VWF monitoring was associated with a lower risk of PPH, but that testing was performed in only one-third of insured pregnant women with VWD in the United States despite expert recommendations.…”

Section: After Application Of Our Inclusion and Exclusion Criteria 2238mentioning

confidence: 99%

See 3 more Smart Citations

Laboratory monitoring during pregnancy and post‐partum hemorrhage in women with von Willebrand disease

O’Brien

Stanek

Kaur

et al. 2020

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

Background Evidence‐based guidelines recommend that von Willebrand factor (VWF) levels be obtained in the third trimester of pregnancy to facilitate peripartum planning for women with von Willebrand disease (VWD). Objectives To identify the frequency of third trimester monitoring in a nationally representative sample of pregnant women with VWD in the United States, as well as the frequency of reproductive bleeding after pregnancy. Patients/Methods Patient data were obtained from the Truven Health MarketScan Research Databases. International Classification of Diseases‐9 codes were used to identify women with VWD and evidence of infant delivery. We defined third trimester monitoring as a laboratory claim for VWF levels during the 3 months before delivery. Clinical outcomes studied included postpartum hemorrhage (PPH) and heavy menstrual bleeding (HMB). Results We identified 2238 unique pregnant females with VWD. Of these, 32% (n = 714) underwent third‐trimester testing of VWF levels. Diagnostic codes consistent with PPH were recorded for 6.5% of women in the 6 weeks after infant delivery. The frequency of PPH in women who underwent VWF monitoring (4.9%) was significantly lower than in those who did not undergo monitoring (7.3%), (risk difference −2.4%, 95% CI −4.4% to −0.3%, P = .023). Diagnostic codes consistent with HMB were recorded for 4.7% of women in the 3 months after infant delivery. Conclusions Third‐trimester VWF monitoring was associated with a lower risk of PPH, but testing was performed in only one‐third of insured pregnant women with VWD in the United States despite expert recommendations.

show abstract

Section: Resultssupporting

confidence: 84%

Section: Resultsmentioning

confidence: 99%

Section: After Application Of Our Inclusion and Exclusion Criteria 2238mentioning

confidence: 99%

Section: After Application Of Our Inclusion and Exclusion Criteria 2238mentioning

confidence: 99%

See 2 more Smart Citations

Laboratory monitoring during pregnancy and post‐partum hemorrhage in women with von Willebrand disease

O’Brien

Stanek

Kaur

et al. 2020

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

show abstract

“…28,58,59 In the general population, secondary PPH rates are approximately 2% 84 ; however, for women with VWD, reported rates vary from 5 to 32% (►Table 2). 3,13,36,53,[85][86][87] Several factors combine to increase this risk. First, the pregnancy-induced rise in VWF and FVIII levels gradually reverses following delivery, with levels declining to baseline by 3 weeks postpartum.…”

Section: Postpartum Monitoring and Secondary Pph In Women With Vwdmentioning

confidence: 99%

Current Challenges in the Peripartum Management of Women with von Willebrand Disease

Byrne

Ryan

Lavin

2021

Semin Thromb Hemost

View full text Add to dashboard Cite

For many women, pregnancy and childbirth represent their first major hemostatic challenges. Despite advancements in obstetric care, up to 2 to 5% of all deliveries are complicated by postpartum hemorrhage (PPH). To mitigate bleeding risk, physiological changes occur in pregnancy, including increases in plasma von Willebrand factor (VWF) and factor VIII levels. For women with von Willebrand disease (VWD), these physiological alterations are blunted or absent. As a result, women with VWD have a heightened risk of PPH, both primary (in the first 24 hours) and secondary (>24 hours to 6 to 12 weeks postpartum). Pregnancy and delivery management for women with VWD should therefore be carefully coordinated as part of a multidisciplinary team approach. In the absence of large-scale clinical trials, the management of women with VWD during pregnancy is guided by expert consensus guidelines. Clinical practices internationally are not uniform, and areas of considerable clinical uncertainty exist. Traditional peripartum plasma VWF thresholds for hemostatic cover and therapeutic targets are currently under scrutiny, as PPH is not eliminated in women with VWD who receive replacement therapy. The benefit and optimal duration of postpartum tranexamic acid have yet to be defined, and standardized methods of quantification of blood loss at the time of delivery are currently lacking. In this article, we review the evidence base to date and explore the current clinical challenges in the management of pregnant women with VWD.

show abstract

Maternal and neonatal bleeding complications in relation to peripartum management in women with Von Willebrand disease: A systematic review

et al. 2020

View full text Add to dashboard Cite

A single‐centre study of management of pregnant women with von Willebrand disease

Cited by 5 publications

References 15 publications

Laboratory monitoring during pregnancy and post‐partum hemorrhage in women with von Willebrand disease

Laboratory monitoring during pregnancy and post‐partum hemorrhage in women with von Willebrand disease

Current Challenges in the Peripartum Management of Women with von Willebrand Disease

Maternal and neonatal bleeding complications in relation to peripartum management in women with Von Willebrand disease: A systematic review

Contact Info

Product

Resources

About