Chapter 117 - Bleeding Disorders in Pregnancy
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AbstractPregnancy may be complicated by the presence of congenital or acquired bleeding disorders that increase the risk of postpartum hemorrhage. Because factor VIII (FVIII) and von Willebrand factor (VWF) increase during pregnancy, von Willebrand disease and FVIII deficiency should be managed using desmopressin (DDAVP) or VWF concentrates according to the VWF and FVIII levels at term and the women's response to desmopressin. Factors IX (FIX) and XI (FXI) do not increase with pregnancy; therefore, treatment of women with FIX or FXI deficiency is based on baseline factor levels and bleeding history. Factor VII (FVII) also increases during normal pregnancy and only women with severely reduced FVII levels at term will require treatment. Of the acquired bleeding disorders, thrombocytopenia is the most common, although etiologies are diverse and consequences range from benign to life-threatening. Treatment depends on the underlying cause—options include observation, corticosteroids or immunoglobulin, plasma exchange, and delivery of the fetus.

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