TRANEXAMIC ACID FOR PREVENTION OF POSTPARTUM HEMORRHAGE IN A VERY YOUNG PRIMIPARA WITH VON WILLEBRAND DISEASE

Abstract

Von Willebrand disease (vWD) is an inherited disorder in the coagulation process. It occurs due to the quantitative or qualitative lack of the von Willenbrand Factor (vWF) coagulation factor. It is clinically presented by mucous bleeding, most commonly nasal, gingival, prolonged and heavy menstrual bleeding, and only in severe forms of the disease, there can be bleeding in the joints and muscles. Treatment of patients with vWD focuses on stopping or preventing episodes of bleeding using medications. With good treatment, patients can have a normal, healthy life. Treating pregnant women with vWD is a particular challenge in many respects: pregnancy bleeding, bleeding in the course of delivery and 4-6 weeks after delivery. vWD may have varying degrees of clinical severity. Serious bleeding may occur in patients with miscarriage or intentional abortion in the first three months of pregnancy due to insufficiently high levels of factor VIII (FVIII). Bleeding in pregnant patients occurs less frequently due to increased concentrations of FVIII and vWF during pregnancy. Their values drop sharply during deli- very and after delivery, so they can cause heavy bleeding. Postpartum hemorrhage can cause serious problems. Antifibrinolytic medications are also used to control post- partum bleeding in patients with vWD. Tranexamic acid (TxA) belongs to that group of medications and has a wide range of effects in hemorrhagic conditions. We present a case of vaginal delivery and postpartum hemorrhage controlled by TxA in a very young primipara (14 years old) who was diagnosed with vWD and completed the pregnancy at 36th gestational week.