Von Willebrand disease in pregnancy: how is care planned?

By trimester

Weeks 1–13

1st trimester

Early pregnancy review should establish the subtype, bleeding history, care team, and procedure precautions.

Weeks 14–27

2nd trimester

During pregnancy, coordinate hematology follow-up and discuss possible labor pain-relief options.

Weeks 28–birth

3rd trimester

In the third trimester, complete the agreed factor checks and document delivery, newborn, and postpartum plans.

What does the evidence show for von willebrand disease?

• Von Willebrand disease affects the amount or function of a protein involved in clotting. Subtypes and bleeding histories differ, so a mild experience in one relative does not establish another person's risk. Previous surgical, dental, menstrual, and delivery bleeding can inform planning. 1
• CDC recommends checking von Willebrand factor and factor VIII levels during the third trimester to help plan delivery. Earlier coordination is also important when prenatal procedures are considered. Tell each clinician about the bleeding disorder before an invasive test or procedure. 2
• The joint ASH, ISTH, NHF, and WFH guideline recommends individualized planning before neuraxial pain relief. A laboratory target does not by itself establish whether an epidural or spinal is appropriate. The anesthesiologist, hematologist, and obstetric clinician should agree on a prospective plan. 3
• Clotting-factor levels that rise during pregnancy fall again after birth. Serious or prolonged postpartum bleeding can therefore occur even when delivery initially went smoothly. Ask for discharge instructions that address bleeding, follow-up, and who to contact after leaving the hospital. 2
• Heavy postpartum bleeding, large clots, dizziness, fainting, chest pain, or trouble breathing are urgent warning signs. Seek immediate assessment instead of assuming that all bleeding is expected after childbirth. Tell emergency clinicians about the known bleeding disorder. 4

Questions to discuss with your care team

When should I call my provider about von willebrand disease?

Heavy bleeding, fainting, severe weakness, or bleeding that does not stop requires urgent assessment.,After birth, seek urgent help for soaking a pad in an hour or large clots, particularly with dizziness.,Chest pain or serious breathing difficulty also needs emergency care; a bleeding disorder does not explain every symptom. If you are ever unsure which side of the line you are on, make the call. Obstetric teams handle these check-ins as routine, not as overreacting.