In pregnant females with Von Willebrand disease (vWD), neuraxial anesthesia can be safely conducted with or without pretreatment depending on vWD severity and type.

A retrospective analysis of a  large case series was carried out for describing the anesthetic management of pregnant females with vWD.

The study included pregnant females diagnosed with vWD. The records of females with vWD in pregnancy who delivered at the institution were examined for demographic characteristics, details of vWD diagnosis, personal and family history of bleeding, lab studies, and overall vWD treatment.

The anesthetic supervision of vWD was at the discernment of individual providers. It was on the basis of multidisciplinary consensus and particular circumstances of each participant's disease and obstetric presentation.

Among 71 individual vWD participants (54 with vWD type 1, 6 with vWD type 2, and 11 with vWD type unknown), 106 deliveries were recognized. About 40.6% (43 cases) were cesarean deliveries. In 88.7% (94/106) of deliveries, neuraxial techniques were used. In 28.7% (27/94) of neuraxial anesthetics, management with desmopressin or Von Willebrand factor/factor VIII concentrate prior to neuraxial anesthesia was carried out.

Postpartum hemorrhage complicated 10.4% (n=11) of deliveries. No detrimental anesthetic outcomes, including thromboembolic events or neuraxial hematoma, were reported.

Most of the parturients with vWD were given neuraxial anesthesia for labor and delivery, without any significant adverse events. In such patients, multidisciplinary planning is crucial for optimizing the coagulation status and expediting options for anesthesia and analgesia. Optimizing the coagulation status permits neuraxial pain relief, facilitates avoidance of general anesthesia, and may potentially reduce postpartum hemorrhage risk.