Postpartum bleeding and von Willebrand's disease.

Area of Science:

• Obstetrics and Gynecology
• Hematology
• Clinical Pathology

Background:

• Postpartum hemorrhage is a significant concern in obstetrics.
• Investigating the causes of excessive postpartum bleeding is crucial for patient management.
• Von Willebrand's disease (vWD) is a potential, though less common, cause of bleeding disorders.

Purpose of the Study:

• To determine the prevalence and characteristics of excessive postpartum bleeding.
• To investigate the role of von Willebrand's disease (vWD I) in postpartum hemorrhage.
• To identify factors associated with significant hemoglobin drops after delivery.

Main Methods:

• Retrospective analysis of 3565 deliveries, comparing hemoglobin levels from delivery to postpartum day 3.
• Inclusion of 14 patients with >8% hemoglobin drop and 10 controls.
• Laboratory testing including plasma von Willebrand factor antigen (vWF:Ag), factor VIII:C activity, and coagulation assays (APTT, Normotest).

Main Results:

• vWF:Ag and factor VIII:C activity were normal in excessive bleeding patients, excluding vWD I.
• Two patients showed isolated decreases in coagulation factors (XI, XII, and VII).
• Mild anemia was diagnosed in 10 of 14 excessive bleeding patients and 1 control.

Conclusions:

• Excessive postpartum bleeding is unlikely to be caused by type I von Willebrand's disease (vWD I).
• Coagulation factor deficiencies can occur in isolation, contributing to bleeding.
• Screening for vWD I should be reserved for women with a prior history of abnormal bleeding.