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3 - Von Willebrand disease and other bleeding disorders in obstetrics

Published online by Cambridge University Press:  01 February 2010

By
Franklin Fuda D.O.  and
Ravindra Sarode M.D.
Edited by
Rodger L. Bick ,
Eugene P. Frenkel ,
William F. Baker  and
Ravi Sarode
Franklin Fuda D.O.
Affiliation:
Fellow: Hematopathology Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
Ravindra Sarode M.D.
Affiliation:
Professor of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
Rodger L. Bick
Affiliation:
University of Texas Southwestern Medical Center, Dallas
Eugene P. Frenkel
Affiliation:
University of Texas Southwestern Medical Center, Dallas
William F. Baker
Affiliation:
University of California, Los Angeles
Ravi Sarode
Affiliation:
University of Texas Southwestern Medical Center, Dallas
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Summary

Introduction

Bleeding disorders in the female population often present unique challenges to an obstetrician. The hormonal and physical changes that occur during the menstrual cycle, pregnancy, childbirth, and the post-partum period continually place strain upon the hemostatic system. Although severe bleeding disorders are usually easily recognized, mild bleeding disorders often go undiagnosed due to the “mild degree” of signs and symptoms (e.g. slightly abnormal menstruation). Unfortunately, even these mild bleeding disorders often lead to a decrease in the quality of life, variable degrees of morbidity, and even life-threatening hemorrhage. Therefore, it is essential that the obstetrician be aware of the clinical clues, appropriate diagnostic tests, and treatment regimens for such disorders. This is particularly important for pregnant women, whose hemostatic system undergoes marked alterations in preparation for the unique challenge of delivery.

The hemostatic system

Basic knowledge of the hemostatic system assists in making clinical decisions regarding bleeding conditions in the obstetric population. Normal hemostasis is a highly regulated, physiologic process of clot formation and clot management that occurs in response to vascular injury. It involves 2 major systems: (i) primary hemostasis and (ii) secondary hemostasis. Although both systems are initiated at the same time and work together intricately to form stable platelet-fibrin clots, the influence that each system has upon clot formation in the arterial versus the venous systems is different.

Type
Chapter
Information
Hematological Complications in Obstetrics, Pregnancy, and Gynecology , pp. 75 - 102
Publisher: Cambridge University Press
Print publication year: 2006

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