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.
Community PollStarted
What vWF activity do you target for pregnant T1 vWD patients during delivery?
18 physicians have voted
Join Mednetto vote and see how they answered.
2 Answers
Mednet MemberInvited Expert
Hematology · University of Pittsburgh Medical Center
Answered on
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...
Join for free or sign in to see the full answer
Mednet MemberInvited Expert
Hematology · University of Rochester
Answered on
I agree with Dr. @Dr. First Last 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 Fr...
Join for free or sign in to see the full answer