{
    "abstract": "von Willebrand disease (VWD) disproportionately affects women because of the potential for heavy menstrual bleeding (HMB), delivery complications, and postpartum hemorrhage (PPH). To systematically synthesize the evidence regarding first-line management of HMB, treatment of women requiring or desiring neuraxial analgesia, and management of PPH. We searched Medline and EMBASE through October 2019 for randomized trials, comparative observational studies, and case series comparing the effects of desmopressin, hormonal therapy, and tranexamic acid (TxA) on HMB; comparing different von Willebrand factor (VWF) levels in women with VWD who were undergoing labor and receiving neuraxial anesthesia; and measuring the effects of TxA on PPH. We conducted duplicate study selection, data abstraction, and appraisal of risk of bias. Whenever possible, we conducted meta-analyses. We assessed the quality of the evidence using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. We included 1 randomized trial, 3 comparative observational studies, and 10 case series. Moderate-certainty evidence showed that desmopressin resulted in a smaller reduction of menstrual blood loss (difference in mean change from baseline, 41.6 [95% confidence interval, 16.6-63.6] points in a pictorial blood assessment chart score) as compared with TxA. There was very-low-certainty evidence about how first-line treatments compare against each other, the effects of different VWF levels in women receiving neuraxial anesthesia, and the effects of postpartum administration of TxA. Most of the evidence relevant to the gynecologic and obstetric management of women with VWD addressed by most guidelines is very low quality. Future studies that address research priorities will be key when updating such guidelines.",
    "authors": [
        {
            "affiliation": "Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.",
            "firstname": "Romina",
            "initials": "R",
            "lastname": "Brignardello-Petersen"
        },
        {
            "affiliation": "Outcomes and Implementation Research Unit, Department of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS.",
            "firstname": "Abdallah",
            "initials": "A",
            "lastname": "El Alayli"
        },
        {
            "affiliation": "Department of Internal Medicine, St. Mary's Hospital, St. Louis, MO.",
            "firstname": "Nedaa",
            "initials": "N",
            "lastname": "Husainat"
        },
        {
            "affiliation": "Department of Internal Medicine, State University of New York at Buffalo, Buffalo, NY.",
            "firstname": "Mohamad A",
            "initials": "MA",
            "lastname": "Kalot"
        },
        {
            "affiliation": "Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.\nDepartment of Pediatrics, McMaster University, Hamilton, ON, Canada.",
            "firstname": "Shaneela",
            "initials": "S",
            "lastname": "Shahid"
        },
        {
            "affiliation": "Lincoln Medical and Mental Health Center, New York, NY.",
            "firstname": "Yazan",
            "initials": "Y",
            "lastname": "Aljabirii"
        },
        {
            "affiliation": "Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS.",
            "firstname": "Alec",
            "initials": "A",
            "lastname": "Britt"
        },
        {
            "affiliation": "Department of Cardiovascular Medicine University of Arkansas for Medical Sciences, Little Rock, AR.",
            "firstname": "Hani",
            "initials": "H",
            "lastname": "Alturkmani"
        },
        {
            "affiliation": "Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.",
            "firstname": "Hussein",
            "initials": "H",
            "lastname": "El-Khechen"
        },
        {
            "affiliation": "Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.",
            "firstname": "Shahrzad",
            "initials": "S",
            "lastname": "Motaghi"
        },
        {
            "affiliation": "Department of Hematology/Oncology, University of Kansas Medical Center, Kansas City, KS.",
            "firstname": "John",
            "initials": "J",
            "lastname": "Roller"
        },
        {
            "affiliation": "The Royal Free National Health Service Foundation (NHS) Hospital and Institute for Women's Health, University College London, London, United Kingdom.",
            "firstname": "Rezan",
            "initials": "R",
            "lastname": "Abdul-Kadir"
        },
        {
            "affiliation": "Maylands, WA, Australia.",
            "firstname": "Susie",
            "initials": "S",
            "lastname": "Couper"
        },
        {
            "affiliation": "Mary M. Gooley Hemophilia Treatment Center, University of Rochester, Rochester, NY.",
            "firstname": "Peter",
            "initials": "P",
            "lastname": "Kouides"
        },
        {
            "affiliation": "Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland.\nNational Coagulation Centre, St. James' Hospital, Dublin, Ireland.",
            "firstname": "Michelle",
            "initials": "M",
            "lastname": "Lavin"
        },
        {
            "affiliation": "Hemocentro UNICAMP, University of Campinas, Campinas, Sao Paulo, Brazil.",
            "firstname": "Margareth C",
            "initials": "MC",
            "lastname": "Ozelo"
        },
        {
            "affiliation": "Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI.",
            "firstname": "Angela",
            "initials": "A",
            "lastname": "Weyand"
        },
        {
            "affiliation": "Department of Medicine, Queen's University, Kingston, ON, Canada.",
            "firstname": "Paula D",
            "initials": "PD",
            "lastname": "James"
        },
        {
            "affiliation": "Hematology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.",
            "firstname": "Nathan T",
            "initials": "NT",
            "lastname": "Connell"
        },
        {
            "affiliation": "Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI; and.\nVersiti Blood Research Institute, Milwaukee, WI.",
            "firstname": "Veronica H",
            "initials": "VH",
            "lastname": "Flood"
        },
        {
            "affiliation": "Outcomes and Implementation Research Unit, Department of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS.",
            "firstname": "Reem A",
            "initials": "RA",
            "lastname": "Mustafa"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2022 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.",
    "doi": "10.1182/bloodadvances.2021005589\n10.1182/bloodadvances.2021005666",
    "journal": "Blood advances",
    "keywords": [],
    "methods": null,
    "publication_date": "2021-10-22",
    "pubmed_id": "34673921\n18315614\n15198765\n31624107\n21632169\n27168829\n10583512\n30042144\n31718817\n9532993\n25333737\n11122390\n17403089\n21805163\n19701049\n30747707\n27478149\n11380629\n31769905\n33570647\n32453843\n21208779\n21839614\n19236375\n16012324\n26231609\n23711358\n27108228\n21310286\n15663130\n18001734\n2400752\n9236645\n19492155\n17941828\n27780267\n27704714\n35339117\n28238590\n25245843",
    "results": null,
    "title": "Gynecologic and obstetric management of women with von Willebrand disease: summary of 3 systematic reviews of the literature.",
    "xml": "<Element 'PubmedArticle' at 0x7885059713f0>"
}