Coagulopathies

Question 1

VWD features

Answer 1

Most common inherited bleeding disorder
Function of VWF :stabilize factor VIII and adherence of platelets to injured vessel walls
Type 1 &2 are AD, type 3 AR
May have prolonged APTT
PT unaffected
Platelets usually unaffected

Question 2

Diagnostic tests for VWD

Answer 2

VWF antigen
VWF Ricof
Factor VIII

VWF and factor VIII increase in pregnancy and therefore difficult to diagnose

Question 3

Pre conception management of VWD

Answer 3

Assess type and response to desmmopressin
Genetic counselling
Prenatal dx in women with type 3 (offer)
Risks of pregnancy and delivery

Question 4

Antenatal care VWD

Answer 4

Prenatal testing
Joint care Obs and haem
VW screen performed in first and third trimester
Anaesthetic assessment
Haemostasis correction should be considered before invasive prenatal testing

Question 5

Intrapartum care of VWD

Answer 5

Type 1: if levels normalized, can have regional anaesthesia
Avoid FSE, FBS, and instrumentals (if have normalized type 1 then just avoid ventouse)
IV access, FBC G &S
Avoid IM injections if VWF levels not normalized
Liars with haem
DDAVP/TXA
Active third stage management

Question 6

DDAVP mech of action

Answer 6

Indirectly stimulates the release of VWF from endothelial cells, causing increased levels of VWF for 4-6 hours
Generally used in type 1