Document Detail


Epidural analgesia for parturients with type 1 von Willebrand disease.
MedLine Citation:
PMID:  17509867     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Epidural analgesia is usually contraindicated in von Willebrand disease. However, in type 1, the increased synthesis of von Willebrand factor (vWF) and factor VIII (FVIII:C) during pregnancy can lead to a correction of biological abnormalities and may allow epidural analgesia to be performed for delivery. METHODS: The clinical files of pregnant patients with type 1 von Willebrand disease who delivered in our tertiary perinatal unit were reviewed. The time profile of hemostasis abnormalities during pregnancy, technical features and complication of epidural analgesia when performed were recorded. RESULTS: Sixteen pregnancies (13 patients) were included. Mean (+/- SD) concentrations of FVIII:C, vWAg, and vWRCo before pregnancy (42+/-12, 46+/-8, 42+/-10 units/dL, respectively) increased to normal values in all cases at term (142+/-42, 142+/-61, 142+/-79 units/dL, respectively). Nine epidurals (6 patients) were performed without complication. Three parturients did not receive epidural analgesia despite normal biological hemostasis because the anesthesiologist was still reluctant to provide it. Four other parturients had PFA-100 closure times (n=3) or a bleeding time that remained prolonged; epidural analgesia was not performed for these cases. CONCLUSIONS: vWF and FVIII:C increased to normal values in all cases at term in these parturients with type 1 von Willebrand disease. Epidural analgesia, when performed for labor, was uncomplicated. However, platelet aggregation tests with PFA-100 unmasked unexpected, persistent abnormalities. The value of this test for clinical decision making remains to be determined by further prospective studies.
Authors:
D Marrache; F J Mercier; C Boyer-Neumann; S Roger-Christoph; D Benhamou
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Publication Detail:
Type:  Journal Article     Date:  2007-05-16
Journal Detail:
Title:  International journal of obstetric anesthesia     Volume:  16     ISSN:  0959-289X     ISO Abbreviation:  Int J Obstet Anesth     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-06-12     Completed Date:  2007-08-28     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  9200430     Medline TA:  Int J Obstet Anesth     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  231-5     Citation Subset:  IM    
Affiliation:
Département d'Anesthésie-Réanimation and Service d'Hématologie Biologique, Hôpital Antoine Béclère - APHP, Clamart cedex, France.
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MeSH Terms
Descriptor/Qualifier:
Adenosine Diphosphate / pharmacology
Adult
Analgesia, Epidural*
Analgesia, Obstetrical*
Bleeding Time
Epinephrine / pharmacology
Factor VIII / analysis
Female
Hemostasis
Humans
Infant, Newborn
Pregnancy
Retrospective Studies
Vasoconstrictor Agents / pharmacology
von Willebrand Diseases / complications*,  physiopathology
von Willebrand Factor / analysis
Chemical
Reg. No./Substance:
0/Vasoconstrictor Agents; 0/von Willebrand Factor; 51-43-4/Epinephrine; 58-64-0/Adenosine Diphosphate; 9001-27-8/Factor VIII

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