Experience with epidural anaesthesia in pregnant women with von Willebrand disease

The use of epidural anaesthesia (EA) in women with von Willebrand disease (vWD) is limited secondary to fears of complications. Currently, there are no standard recommendations for the use of EA in women with vWD. A retrospective chart review was performed of women with vWD who received EA at the time of term pregnancy. EA was administered to 15 women at the time of 17 deliveries, four by caesarian section and 13 by normal spontaneous vaginal delivery. Ninety-three per cent of these women had type 1 vWD. None of the women received DDAVP or clotting factor concentrates prior to the administration of EA. There were no complications directly related to EA. Postpartum haemorrhage did occur in 47% of the deliveries, with three women requiring blood transfusion. In this small series, EA appears to be safely administered to pregnant type 1 vWD patients at the time of term delivery.