Information About VWD for Obstetricians and Gynecologists

Prevalence

VWD is the most common inherited bleeding disorder in women (0.6-1.3%).1 The overall prevalence is even higher among women with chronic heavy menstrual bleeding, ranging from 5% to 24%.2,3

Symptoms

Abnormal uterine bleeding is a commonly reported symptom among women diagnosed with von Willebrand disease, with 74-92% experiencing heavy menstrual bleeding.4 Additional symptoms or signs that may be present include epistaxis (38-63%), bleeding gums (26%). -35), bleeding after tooth extraction (29-52%), bleeding from minor cuts or abrasions (36%), post-operative bleeding (20-28%), gastrointestinal bleeding (14%), and joint bleeding (6-8%) has.5,6

Diagnosis

Clinical Screening of Underlying Hemostasis Disorder in an Adult Patient with Excessive Menstrual Bleeding *

Initial screening for an underlying haemostasis disorder in patients with excessive menstrual bleeding should be structured based on medical history. A positive scan result* consists of: 7

  • Heavy menstrual bleeding since menarche
  • One of the following conditions
    • Postpartum hemorrhage
    • Bleeding due to surgery
    • Bleeding associated with dental intervention
  • Two or more of the following conditions:
    • Epistaxis, once to twice a month
    • Frequent bleeding gums
    • Family history of bleeding symptoms

* Patients with a positive screening result should be considered for further evaluation, including consultation with a hematologist and testing for von Willebrand factor and ristocetin cofactor.

Screening for Adolescent Patients Reporting Heavy Menstrual Bleeding

If a patient meets one or more of the following criteria, this indicates a positive screening result and requires further evaluation9:

  • Periods lasting longer than 7 days or bleeding from a pad or tampon
  • History of anemia
  • Family history of bleeding disorder
  • History of bleeding disorder after hemostatic challenge (i.e. tooth extraction, surgery, delivery)
Treatment

Once von Willebrand disease is diagnosed, a multidisciplinary management approach involving the obstetrician-gynecologist and haematologists results in optimal treatment outcomes.8 Patients should be reminded that drugs that inhibit platelet adhesion, such as aspirin or nonsteroidal anti-inflammatory drugs, should be avoided after von Willebrand disease is diagnosed.6

References
  1. James AH. Von Willebrand disease. Obstet Gynecol Surv 2006;61:136–45
  2. James AH. Obstetric management of adolescents with bleeding disorders. J Pediatr Adolesc Gynecol 2010;23:S31–7
  3. Shankar M, Lee CA, Sabin CA, Economides DL, Kadir RA. von Willebrand disease in women with menorrhagia: a systematic review. BJOG 2004;111:734–40.
  4. James AH, Kouides PA, Abdul-Kadir R, Dietrich JE, Edlund M, Federici AB, et al. Evaluation and management of acute menorrhagia in women with and without underlying bleeding disorders: consensus from an international expert panel. Eur J Obstet Gynecol Reprod Biol 2011;158:124–34.
  5. Valente MJ, Abramson N. Easy bruisability. South Med J 2006;99:366–70.
  6. NationalHeart , Lung, and Blood Institute. The diagnosis, evaluation, and management of von Willebrand disease. NIH Publication No. 08-5832 . Bethesda (MD): NHLBI; 2007. http://www.nhlbi.nih.gov/guidelines/vwd/vwd.pdf. Accessed on January 29, 2021.
  7. Kouides PA, Conard J, Peyvandi F, Lukes A, Kadir R. Hemostasis and menstruation: appropriate investigation for underlying disorders of hemostasis in women with excessive menstrual bleeding. Fertil Steril 2005;84:1345–51.
  8. Kadir RA, Lukes AS, Kouides PA, Fernandez H, Goudemand J. Management of excessive menstrual bleeding in women with hemostatic disorders. Fertil Steril 2005;84:1352–9
  9. Philipp CS, Faiz A, Dowling NF, Beckman M, Owens S, Ayers C, et al. Development of a screening tool for identifying women with menorrhagia for hemostatic evaluation. Am J Obstet Gynecol 2008;198:163.