Pregnancy and delivery in patients with von Willebrand's disease

To explore the obstetrical problems that are encountered in women with von Willebrand's disease (vWD).

Case histories of 6 women whose pregnancies were complicated by vWD were reviewed retrospectively over an 11-year period. The disease had been diagnosed before pregnancy in only 2 cases. The 6 women had a total of 10 deliveries, 3 induced abortions, and 1 spontaneous abortion.

Although all 6 women had Type-I vWD, their laboratory data and bleeding symptoms varied. The 10 full-term deliveries were all vaginal. Heat-treated concentrated Factor-VIII preparations were administered in 2 cases, in both of which abortions were induced during the 2nd trimester. Genital bleeding persisted in the second case, so that the administration of Factor VIII was repeated, and the patient underwent uterine curettage on the 12th day after abortion. Desmopressin was administered before the early induction of abortion in 1 case. The patient with persistent genital bleeding after spontaneous abortion received Factor VIII for 5 consecutive days.

Bleeding problems occurred about 1 week after delivery or at the time of induced abortion in the 6 women with vWD. Thus, such patients require special care during pregnancy.