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Master Thesis

Maladie de Willebrand et grossesse : étude de cas au CHU d'Angers

Abstract : Objective: Von Willebrand disease is the most common inherited bleeding disorder. It is defined by quantitative or qualitative abnormalities of Von Willebrand factor and is classified into three different types. Women with Von Willebrand's disease are at an increased risk of bleeding complications during pregnancy, peripartum and postpartum period. The aim of this work was to determine the impact of the pregnancy in women with Von Willebrand disease and conversely, to assess the obstetric outcome in these women. Moreover, this study was performed to define the role of the midwives in the management of these women.

Population and methods: A retrospective study was performed to the CHU of Angers from January 2004 to December 2009. Twenty five women were included. Among them, we decided to study five (seven pregnancies). Results were confronted with those of the literature.

Results: Our study showed that the management of the pregnancy varies according to the type of Von Willebrand disease. There is a physiological increase in Von Willebrand factor levels during pregnancy but this increase depends on the variant of Von Willebrand disease. Indeed, we observe a sufficient increase rates in types 1, variable in types 2 and absent in types 3. The use of epidural anaesthesia in women with Von Willebrand disease depends closely on these rates. In our study, only one epidural anaesthesia was performed in a parturient with type 1 Von Willebrand disease. Moreover, we showed an increased risk of hemorrhagic complications in the peripartum period. In our study, we reported 42, 8% of primary or secondary postpartum haemorrhage.

Discussion and conclusions: The review of the literature confirms our results and insists on the need for close collaboration between obstetricians, anaesthesiologists and hematologists. The midwife is involved in this close collaboration. The rates of factors must be controlled regularly during the pregnancy and a written protocol of management must be enclosed in the patient's notes by indicating if a prophylactic treatment is useful.

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Submitted on : Thursday, March 10, 2011 - 5:45:48 PM
Last modification on : Friday, May 10, 2019 - 1:26:01 PM
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  • HAL Id : dumas-00575632, version 1

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Loren Martineau. Maladie de Willebrand et grossesse : étude de cas au CHU d'Angers. Gynécologie et obstétrique. 2010. ⟨dumas-00575632⟩

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