Monozygotic twins monocorial childbirth in a primipara patient suffering from von Willebrand disease. follow up during pregnancy and prophylaxis of surgical caesarean
Abstract number: PP-MO-635
Gagliano1 F., Maiorana2 A., Amodeo1 R., Guido1 R., Dantona1 G.
11Thrombosis and haemostasis service of Immuno-Hematology and Department of Transfusional 22Department of Gynaecology and Obstetrian, A.R.N.A.S Civico Hospital Palermo, Palermo, Italy
How-to-cite Gagliano F, Maiorana A, Amodeo R, Guido R, Dantona G. Monozygotic twins monocorial childbirth in a primipara patient suffering from von Willebrand disease. follow up during pregnancy and prophylaxis of surgical caesarean. Journal of Thrombosis and Haemostasis 2009; Volume 7, Supplement 2: Abstract PP-MO-635
In women suffering from von Willebrand disease (vWD) pregnancy is difficult. Monozygotic twin pregnancy monocorial leads to further problems for the mother and fetus. The intrauterine death of a twin occurs in 2–5% of twin pregnancies. For the twins monocorials frequency is 3–4 times greater than in bicorials. The maternal risk is the retention of miscarriage which can give rise to consumption coagulopathy. The twin pregnancy may present maternal complications. In the first trimester is usually seen an increased tendency to abortion than the single pregnancy. Pregnant twins primipara have a five times greater risk of developing pre-eclampsia. The risk of gestational hypertension appears to be higher. Postpartum haemorrhage is more common and appears to be due both to the larger area of placental insertion and the uterine sovradistensione with increased tendency to atony uteri.
Methods: The patient is a woman aged 24 years diagnosed with type IIA vWD. At the time of diagnosis shows vWAg46% and vWRco30%. During the pregnancy no haemorrhagic episodes were observed. The hemodynamic situation has discouraged the use of desmopressin as surgical prophylaxis and for the resolution of any haemorrhagic complications. The patient has undergone a Caesarean Section (CS) to 38th week of pregnancy using the prophylaxis with FVIII + FvW (Haemate-P CSL Behring) proposed by Berntorp based on FvWRco initial value of the last control before the pregnancy (30%): loading dose of Haemate-P CSL Behring: 35 IU/kg i.V. bolus 60’ before the delivery and every 8 h the first day, maintenance dose of 17.5 IU/kg every 12 h until the 7th day. Sutures were performed at separate points and was placed drainage spy, who was removed on third day. From the second day was carried out antithrombotic prophylaxis with low molecular weight heparin. The CS was done regularly without any complication or bleeding for the two female fetuses. The post operative course was smooth and there were no or haemorrhagic or thrombotic events.
Conclusions: The case presented is unique and has worried the obstetrician and haematologist. However, a clear assessment of the situation made it possible to apply the latest prophylactic protocols obtaining the best results we could expect.
Disclosure of interest: none declared.
To cite this abstract use the following format:
Journal of Thrombosis and Haemostasis 2007; Volume 5, Supplement 2: abstract number
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