This document summarizes the intrapartum management of pregnant women with hereditary coagulation disorders. It presents the case of a 26-year-old pregnant woman diagnosed with von Willebrand disease who was later found to be a carrier of hemophilia A after her son was born with hemophilia A. It then reviews the intrapartum management of patients with hereditary coagulopathies and proposes a protocol for studying and managing affected patients and their children. The protocol includes treatment with desmopressin, factor VIII concentrate, and tranexamic acid during pregnancy, labor, and the postpartum period.

1. “MANEJO INTRAPARTO DE
EMBARAZADAS CON
TRASTORNOS
HEREDITARIOS DE LA
COAGULACIÓN”
Autores: Paulina Merino O, Pamela Zúñiga C, Jorge Carvajal
C. PhD , Diego Mezzano A
Publicado: REV CHIL OBSTET GINECOOL
Año de publicación: 2006

2. INTRODUCCIÓN
“33 mujeres mueren cada hora por completo cada hora por
complicaciones del embarazo y el parto” → Organización mundial de la
salud.
Hemofilia A
Enfermedad
Von
Willebrand
A nivel
mundial:
A nivel nacional:
1/10.000 personas
5000 - 10.000 varones
afectados → 85% de los casos
pertenecen a este tipo de
hemofilia.

3. OBJETIVO DEL ESTUDIO
Presentar el caso clínico de una mujer
embarazada portadora de hemofilia A, y
realizar una revisión respecto del manejo
intraparto de pacientes con coagulopatías
hereditarias, para proponer un protocolo de
estudio y manejo de las pacientes y sus hijos.

4. CASO CLÍNICO
Paciente de 26 años, nulípara, inicia control en la red de salud cursando embarazo
de 8 semanas. Como antecedentes destaca el diagnóstico durante la adolescencia
de enfermedad de Von Willebrand oligosintomática, usuaria de desmopresina en
forma ocasional. Refiere, además, el antecedente de familiares de primer grado
con diagnóstico de hemofilia A grave.
Pruebas Paciente Valor normal
TTPA 32,2% 26 - 40 seg
TP 125% 70 - 120%
FVIIIc 42% 35 - 300%
FvW antigénico 85% 44 - 206%
FvW cofactor
ristocetina
79% 34 - 167%
Union de FvW a
colágeno
85% 47 - 300%

5. Se le realiza cesárea, obteniéndose un recién
nacido, con un Apgar 8-9, con pequeño
cefalohematoma. El recién nacido es
hospitalizado al día siguiente del parto por
sospecha de infección connatal, por
irritabilidad y succión débil. → El recién nacido
es dado de alta en buenas condiciones
generales a los 7 días tras haber completado el
curso de antibiótico.
Prueba Paciente
Exámen físico
Destacaba que el
cefalohematoma había
aumentado de tamaño
Leucocitos
Leucocitosis con
desviación a la
izquierda
TTPK Prolongado
FVIII <1%
Diagnóstico:
Hemofilia A
severa
Tratamiento FVIII liofilizado

6. Alteraciones
cardiovasculares
Trastornos
metabólicos
Transtornos
hemostáticos
Aumento del volumen
plasmático.
Alteración en la presión
periférica.
Liberación exacerbada a
nivel de hormonas.
Aumenta en el tercer
trimestre y corpóreo
EMBARAZO Y HEMOSTASIA

7. PROTOCOLO DE EMBARAZADA
Es fundamental el
manejo interdisciplinario
El protocolo
incluye periodo de
embarazo,parto y
puerperio.
Tratamiento:
Desmopresina,Factor VIII
Liofilizado y Acido
tranexamico

8. OTROS TRASTORNOS INFRECUENTES
DE LA COAGULACIÓN
Trastornos del
fibrinogeno (factor I)
Deficiencia del
factor XI
Deficiencia de factor
II
Deficiencia de factor
X
Deficiencia de factor
XIII
Deficiencia de factor
XII

9. RESULTADO

10. DISCUSIÓN
Portadora de
hemofilia
Enfermedad
Von Willebrand
tipo N2
FvW normal → cofactor
ristocetina dentro de los rango
normales
Discrepancia con la actividad o
valor del factor VIII
Hijo nacio en condiciones
normales; salvo presencia de
un cefalohematoma,
leucocitosis, Desv. a la
izquierda, TTPK prolongado,
FVIII <1%
Posible diagnóstico
que la madre era
portadora de
hemofilia tras el
nacimiento de su hijo.

11. CONCLUSIÓN

12. REFERENCIA BIBLIOGRAFICA

14. Mars
Mercury
Venus
Saturn
Innovations
Despite being red, Mars is
a very cold place
Venus is the second
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Mercury is the closest
planet to the Sun
Saturn is a gas giant and
has several rings

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18. Mission Vision
Mercury is the closest planet to the Sun
and the smallest one in the Solar
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Moon. The planet’s name has nothing to
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Venus has a beautiful name and is the
second planet from the Sun. It’s terribly
hot—even hotter than Mercury. It’s the
second-brightest natural object in the
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Jupiter
Jupiter is the biggest
planet of them all
Venus
It’s the second
planet from the Sun
Mars
Despite being red,
Mars is a cold place
Mercury
Mercury is the
smallest planet
40%
35%
15%
10%

21. Awesome
words

22. A brief story
Mercury is the closest planet to the Sun
and the smallest one in the Solar System—
it’s only a bit larger than the Moon. The
planet’s name has nothing to do with the
liquid metal, since Mercury was named
after the Roman messenger god

23. Milestones reached
2XXX 2XXX 2XXX 2XXX
Venus
Venus is the second
planet from the Sun
Mercury
Mercury is the closest
planet to the Sun
Mars
Despite being red,
Mars is a cold place
Saturn
Saturn is a gas giant
and has several rings
2XXX
Jupiter
Jupiter is the biggest
planet of them all

24. Our process
Venus
Venus is the second
planet from the Sun
Mars
Despite being red,
Mars is a cold place
Jupiter
Jupiter is the biggest
planet of them all
Saturn
30%
20%
50%
Mercury
Mercury is the closest planet
to the Sun and the smallest
one in the Solar System

25. A picture is worth
a thousand words

26. Patient care
Mercury is the closest planet to the Sun and
the smallest one in the Solar System—it’s
only a bit larger than the Moon. The planet’s
name has nothing to do with the liquid
metal, since Mercury was named after the
Roman messenger god

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28. Areas we cover
Jupiter Mercury Venus Mars
Area 1 ✔ ✖ ✔ ✖
Area 2 ✖ ✔ ✔ ✖
Area 3 ✔ ✖ ✔ ✔
Area 4 ✖ ✔ ✖ ✔

29. Key accomplishments
2XXX 2XXX
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30. Mercury is the closest planet to the Sun and
the smallest one in the Solar System—it’s only
a bit larger than the Moon
95%

31. Care centers
Mercury
Mercury is the closest planet
to the Sun and the smallest
one in the entire Solar
System. This planet’s name
has nothing to do with the
liquid metal, since Mercury
was named after the Roman
messenger god

32. Mercury Neptune
Venus Mars Saturn
Jupiter
Quality improvement measures
Mercury is the closest
planet to the Sun
Jupiter is the biggest
planet of them all
Venus is the second
planet from the Sun
Mars is actually a very
cold place
Saturn is composed of
hydrogen and helium
Neptune is very far
away from the Sun

33. Testimonials
Richard Jackson, 58
“Neptune is the fourth-largest planet by
diameter in the entire Solar System”
“Mercury is the closest planet to the Sun
and the smallest one in the Solar System”
“Saturn is the ringed planet. It’s
composed mostly of hydrogen and
helium”
Jenna Doe, 25
John James, 36

34. Our team
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Mars
Jupiter
Mercury is the closest
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Despite being red, Mars is
a cold place
Venus is the second
planet from the Sun
Jupiter is a gas giant and
the biggest planet

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