Please select the option that best describes you:
Topics:
Hematology • Benign Hematology • Pregnancy • Von Willebrand • Obstetrics & Gynecology • Bleeding disorders
How do you approach delivery planning in patients with T1 vWD?
Do you routinely recommend a C-section over vaginal delivery? Induced vs spontaneous?
If a C-section is needed, do you prefer general anesthesia over an epidural?
How do you decide the duration of vWF treatment in the absence of prior hemostatic challenges and no major bleeding events? For example, the patient has heavy menses, but no prior surgical challenges.
Answer from: at Academic Institution
For VWD, I recommend that the mode and timing of delivery be obstetric-based (i.e., the presence of VWD has no effect on the decision). If a CSX is needed, I consider an epidural safe if preceded by VWD-specific therapy. I base the duration of VWD-specific therapy on clinical history and 3rd-trimest...
Sign In or Register to read more
Answer from: at Academic Institution
I agree with Dr. @Seaman's comments. Also, while it's a conditional recommendation per the 2021 VWD guidelines (Connell et al., PMID 33570647), we usually offer TXA 1.3 g po tid for 10-14 d as there is a sizable risk of secondary PPH as VWF levels start to fall as early as 3 days (per Royal Free exp...