Manejo de la enfermedad de von Willebrand en ginecología y obstetricia. Revisión cualitativa de la literatura
DOI:
https://doi.org/10.18597/rcog.284Palabras clave:
enfermedad de Von Willebrand, antifibrinolíticos, ácido tranexámico, ácido epsilón aminocaproico, desmopresina, concentrado de FVW/ FVIII, hemorragias ginecológicas y obstétricasResumen
Introducción: la enfermedad de Von Willebrand es el trastorno de la coagulación con mayor prevalencia de mujeres en edad fértil y, por lo tanto, es el trastorno genético de la hemostasia más frecuente en la práctica ginecológica y obstétrica.
Objetivo: hacer una revisión de la enfermedad de Von Willebrand en pacientes de ginecología y obstetricia con especial énfasis en la fisiopatología, el diagnóstico y el tratamiento.
Metodología: se realizó una búsqueda bibliográfica en las bases de datos electrónicas MEDLINE/ Pubmed, Elsevier, Interscience, EBSCO, Scopus, SciELO de 1980 al 2009, Cochrane Pregnancy and Childbirth Group (septiembre 30 del 2009) y libros de texto impresos.
Resultados: el diagnóstico se basa en una cuidadosa anamnesis y pruebas de laboratorio de detección y confirmatorias. La correcta identificación de los diferentes tipos y subtipos es importante desde el punto de vista terapéutico. El tratamiento requiere medicaciones específicas como la desmopresina, concentrados de factor VIII y terapias coadyuvantes. No existe evidencia para contraindicar la vía vaginal del parto, sin embargo, se debe individualizar cada caso en particular.
Conclusión: las mujeres con trastornos de la coagulación presentan durante la menarquia, la gestación, el parto y el puerperio un riesgo mayor de sangrado lo que hace obligatoria una adecuada evaluación y un manejo multidisciplinario durante el embarazo.
Biografía del autor/a
Franklin J. Espitia-De La Hoz
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