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Observational Study
.2016 Oct 25;11(10):e0164683.
doi: 10.1371/journal.pone.0164683. eCollection 2016.

Postpartum Hemorrhage in Women with Von Willebrand Disease - A Retrospective Observational Study

Affiliations
Observational Study

Postpartum Hemorrhage in Women with Von Willebrand Disease - A Retrospective Observational Study

Igor Govorov et al. PLoS One..

Erratum in

Abstract

Introduction: von Willebrand disease (VWD) is a hereditary bleeding disorder, caused by a deficiency in the levels and/or function of von Willebrand factor (VWF). Women with VWD appear to be at increased risk of experiencing postpartum hemorrhage (PPH), though the levels of VWF increase during pregnancy. There is limited knowledge of how PPH is associated with the subtype of VWD, plasma levels of other coagulations factors than VWF and given hemostatic treatment.

Aims: The aims were to investigate the incidence of PPH in women with VWD and to analyse the correlation between PPH and: (1) type of VWD, (2) laboratory monitoring of VWF and FVIII and (3) hemostatic drug treatment.

Methods: This was a retrospective observational study. The study participants (n = 34) were recruited from the Coagulation Unit, Karolinska University hospital. Fifty-nine deliveries, which occurred in 14 different obstetrics units (years 1995-2012) were included in the study.

Results: The incidence of primary PPH was 44%, severe primary PPH 20% and secondary PPH 12%. VWD type 3 was associated with a higher risk of experiencing severe primary PPH compared to other subtypes. FVIII:C in pregnancy was inversely correlated to blood loss during delivery. There was a significantly higher incidence of secondary PPH when the VWD diagnosis was unknown at time of delivery.

Conclusions: The women with VWD are at higher risk of PPH, especially those with type 3 VWD or when diagnosis is unknown prior to delivery. Identification of pregnant women with undiagnosed VWD may be of importance in order to prevent PPH.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart for inclusion process.
Fig 2
Fig 2. Distribution of blood loss.
Fig 3
Fig 3. Blood loss (ml) in association with delivery in the different subtypes of von Willebrand disease (VWD).
Fig 4
Fig 4. Total dose of clotting factor concentrate (CFC) in the three different subtypes of von Willebrand disease (VWD).
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