Kailash F, Wilkerson D
J Ark Med Soc. 2009 May;105(11):259-60, 262.
Fearing the devastating neurological complications in a parturient with the von Willebrand disease secondary to paucity of studies defining the guidelines to assess the risk of bleeding complications, anesthesiologists are often reluctant to administer neuroaxial anesthesia. We present a case report of a parturient with type I von Willebrand disease who presented for induction of labor at 39 weeks of gestation. After consultation with the hematologist well ahead of the conception, appropriate laboratory workup including clotting factor levels including FVIII, vWF:RcoF, vWF:Ag on different occasions peripartum, and provision of adequate prophylactic medical treatment, she underwent Cesarean section under epidural anesthesia without neurological or bleeding complications. von Willebrand disease is the most common inherited bleeding disorder that may result in various bleeding complications in a parturient as a result of hemostatic challenges during pregnancy. Yet the recommendations are based on anecdotal observations of the authors of small case series and surveys. Our case report emphasizes the importance of advanced planning, careful patient assessment, and multi-disciplinary team approach for the successful regional anesthesia as suggested by the guidelines based on clinical experiences.
由于缺乏明确评估出血并发症风险指南的研究，担心血管性血友病产妇会出现毁灭性的神经并发症，麻醉医生通常不愿实施神经轴索麻醉。我们报告一例I型血管性血友病产妇，在妊娠39周时前来引产。在受孕前就与血液科医生进行了会诊，进行了适当的实验室检查，包括围产期不同时间的凝血因子水平，如FVIII、vWF:RcoF、vWF:Ag，并提供了充分的预防性治疗，她在硬膜外麻醉下接受了剖宫产，未出现神经或出血并发症。血管性血友病是最常见的遗传性出血性疾病，由于妊娠期间的止血挑战，可能导致产妇出现各种出血并发症。然而，这些建议是基于小病例系列和调查的作者的轶事观察。我们的病例报告强调了根据临床经验制定的指南所建议的提前规划、仔细的患者评估和多学科团队方法对于成功实施区域麻醉的重要性。
