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  • Title: [Treatment with desmopressin before epidural anesthesia in a patient with type I von Willebrand disease].
    Author: Pérez-Barrero P, Gil L, Martínez C, Bueno AB, Casado AI, Oro J.
    Journal: Rev Esp Anestesiol Reanim; 2003 Dec; 50(10):526-9. PubMed ID: 14737779.
    Abstract:
    A 33-year-old primipara with von Willebrand disease type I was admitted in labor at 37 weeks, requesting epidural analgesia. The consultant hematologist advised treating with desmopressin acetate (DDAVP) before inserting an epidural catheter. Desmopressin at a dose of 0.3 microgram/Kg was administered intravenously and the catheter was inserted to L3-L4 to infuse 0.1% bupivacaine with 2 micrograms/mL of fentanyl at a rate of 12 mL/h. Four hours later the patient was brought to the operating room for forceps delivery of a healthy boy. One hour later, she had recovered normal motor tone followed by normal sensitivity in the lower extremities. The catheter was then withdrawn with no signs of bleeding. A woman with von Willebrand's disease can receive an epidural block for analgesia during childbirth. The decision to perform the block should be individualized, based on coagulation tests. DDAVP may play a role in improving hemostasis.
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