Changes in the levels of factor VIII and von Willebrand factor in the puerperium

Abstract

To determine changes in Factor VIII (FVIII) and von Willebrand Factor (VWF) in the first 3 days of the puerperium. A prospective study assessing FVIII clotting activity, VWF activity and antigen levels in 95 women (with singleton uncomplicated pregnancies) during labour and on days 1, 2 and 3 of the puerperium. There were no significant differences in FVIII, VWF:Ag and VWF:CB on days 1 and 2 of the puerperium compared with levels during labour. There was a significant decrease in VWF:Ag (P = 0.009) and VWF:CB (P = 0.04) on day 3. Age, ethnicity, duration of labour and mode of delivery did not have any significant effect on the changes in FVIII and VWF levels. The pregnancy induced increase in FVIII and VWF is maintained in the first 48 h after delivery. VWF levels start to decline on day 3 postdelivery.

Blood volume–based von Willebrand factor to prevent postpartum hemorrhage in von Willebrand disease

“…7 Postpartum blood loss in VWD At delivery, the mean estimated blood loss in women with VWD is 1.4-fold greater than in controls, 615 vs 448 mL, despite VWF concentrate treatment, and continues over the next 6 weeks postpartum, accompanied by a significantly lower hematocrit, 28.6% 7 ( Figure 1B). These findings, confirmed in retrospective studies, [8][9][10][11] remain poorly understood. Why do women with VWD experience excessive postpartum blood loss despite treatment?…”

“…[9][10][11] In women with VWD, a recent prospective study indicates the trajectories of VWF:RCo, VWF:Ag, and FVIII:C, although parallel to those in control women without VWD, do not increase to the same degree and fall more rapidly than controls.…”

Management of VWD

“…23 VWF and FVIII levels begin to fall even by day 3 postpartum in healthy women and return to baseline levels by day 14. 24 For women with VWD, this fall can be associated with significant postpartum hemorrhage. 23 The average time of presentation of postpartum hemorrhage in women with VWD is 15.7 days 25 ; therefore, patients may require prophylaxis for 2 weeks or more.…”

Prise en charge anténatale des patientes à risque d’hémorragie du post-partum (hors anomalies de l’insertion placentaire)

“…Même si les taux de FVW et de FVIII s'élèvent pendant la grossesse, ils n'atteignent pas ceux atteints par les femmes sans MVW, ce qui explique en partie le risque persistant d'HPP. Après l'accouchement, les taux de facteur peuvent chuter à partir du 3 e jour et retrouvent leurs taux initiaux en 3 semaines mais il existe une importante variabilité interindividuelle [40,41]. Chez les femmes ayant reçu une prophylaxie pendant l'accouchement, cette dernière doit être poursuivie pendant au moins 3 à 5 jours selon le type d'accouchement (voire plus longtemps selon le contexte) (grade C).…”