What are the recommended management strategies for a pregnant patient with a known history of von Willebrand disease?

For a pregnant patient with a known history of von Willebrand disease, the recommended management strategies include:

• Plan birth in an obstetric-led unit with access to a neonatal unit capable of high-dependency care to manage potential bleeding risks for both mother and baby.
• Active management of the third stage of labour is advised rather than physiological management to reduce the risk of postpartum haemorrhage.
• Avoid intramuscular injections of uterotonics to minimise bleeding risk.
• Individualised postpartum care should be arranged in consultation with a senior haematologist, including measurement of blood loss, monitoring for obstetric complications, and haematological parameters.
• Inform the woman about the risk of secondary postpartum bleeding and how to access care after discharge.
• Be cautious with the use of non-steroidal anti-inflammatory drugs as they can increase bleeding risk.

These strategies aim to reduce bleeding complications associated with von Willebrand disease during pregnancy, labour, and postpartum.