Analgesia and Anesthesia for Pregnant Women with Inherited Bleeding Disorders

Pregnancy in special populations: challenges and solutions practical aspects of managing von Willebrand disease in pregnancy

“…Active man age ment of the third stage of labor, which incor po rates pro phy lac tic use of uterotonic (oxy to cin), early clamping, and con trolled cord trac tion to deliver the pla centa, reduces the risk of severe pri mary Table 2. Conditions for the use of regional block in women with IBDs dur ing labor and deliv ery 36 Multidisciplinary man age ment involv ing hema tol o gists, anes the tists, obste tri cians, and the mother Detailed coun sel ing on the ben e fits and risks of regional block and its alter na tives to help the mother make an informed deci sion Careful assess ment of coag u la tion sta tus, includ ing assess ment of clot ting fac tor dur ing the third tri mes ter, and bleed ing phe no type, includ ing per sonal and fam ily bleed ing his tory Availability of ther a peu tic prod ucts and lab o ra tory facil i ties to ensure ade quate response to treat ment Plan of man age ment made ante na tally dur ing the third tri mes ter, clearly documented, and read ily avail able to pro fes sion als attend ing the woman in labor Normalization of coag u la tion defect by either a preg nancyinduced rise in coag u la tion fac tors or the use of appro pri ate pro phy lac tic treat ment prior to regional block pro ce dures Meticulous tech ni cal skills in the admin is tra tion of regional block by an expe ri enced anes the tist Where an epi du ral cath e ter is placed, ade quate hemo sta sis should be maintained prior to cath e ter removal, as the risk of bleed ing is no less than with inser tion Awareness and sur veil lance for symp toms and signs of poten tial com pli ca tions PPH greater than 1000 mL 42 and should be implemented for all women with IBDs. Additional uterotonic agents such as pros ta glan din E2 (misoprostol) have been recommended for pro phy lac tic use in women with mod er ate and severe IBDs.…”