3 kg (range 2.2–4.5 kg)

with the use of DDAVP. Indications for DDAVP in this study were prior to labour to prevent postpartum haemorrhage, to treat retroplacental haemorrhage Nutlin-3a and prior to cervical cerclage. There were no recorded maternal hyponatraemia or thromboembolic events in this study [15]. This article reviews the currently available evidence for the use of DDAVP in pregnancy in women with bleeding disorders. Pregnancy and childbirth present significant management challenges to Obstetricians and Haematologists who need to ensure that the risk of bleeding complications are minimized and that effective treatments are initiated rapidly when they do occur. DDAVP is effective in selected cases and has the benefit of avoiding buy CP-868596 the risk of blood-borne viruses associated with blood products. A test dose is advised to establish a therapeutic effect in the patient and has been shown to be an effective prophylaxis or treatment option in VWD, haemophilia A and functional platelet disorders [35]. The main therapeutic action of DDAVP is to increase FVIII levels and to stimulate VWF release from endothelial cells. Optimal increase in FVIII and VWF can be achieved using a dose of 0.3 μg kg−1 DDAVP as an intravenous infusion [35].

The subcutaneous route has been shown to also been shown to be effective medchemexpress but peak levels are reached more slowly. A recent study comparing response to 15 μg subcutaneous DDAVP to the standard 0.3 μg kg−1 i.v. found comparable responses to the different doses at one hour for patients with mild VWD and haemophilia A [36]. Three hundred microgram intranasally may also be used and this has been shown to provide the equivalent improvement in haemostasis as 0.2 μg kg−1 i.v. DDAVP infusion with similar reproducibility as the intravenous dose [37,38]. Most studies included in this article reported use of an intravenous infusion

of DDAVP with intranasal use only recorded in two studies [11,31]. Desmopressin has been used successfully in the first and early second trimesters for bleeding prophylaxis before invasive procedures in cases of VWD and haemophilia A carriers. Factor VIII and VWF levels increase throughout pregnancy in women with normal coagulation as well as in haemophilia A carriers and VWD patients. In the latter group, with low baseline VWF and FVIII levels, the increase becomes significant to improve haemostasis only after the second trimester. Thus, any invasive procedure such as prenatal diagnosis technique can be associated with a significant risk of bleeding [16]. There is evidence of safe use of DDAVP for first trimester bleeding prophylaxis for chorionic villus sampling, amniocentesis and termination of pregnancy in several studies [8,18,24].