deamino-arginine-vasopressin and Abruptio-Placentae

Von Willebrand disease is the most common inherited blood disorder, occurring in about 1% of the population. It results from a deficiency in the quality or quantity of von Willebrand factor, which is necessary for adequate hemostasis. An evidenced-based approach is prudent when this derangement is coupled with a potentially fatal obstetric complication. This article examines the anesthetic management of a parturient with a known diagnosis of von Willebrand disease who presented to the labor and delivery unit in active labor and with a suspected uterine placental abruption.

Topics: Abruptio Placentae; Adult; Anesthesia, Obstetrical; Cesarean Section; Deamino Arginine Vasopressin; Diagnosis, Differential; Female; Humans; Nurse Anesthetists; Perinatal Care; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Outcome; von Willebrand Disease, Type 1

Postpartum, diabetes insipidus (DI) can be part of Sheehan's syndrome or lymphocytic hypophysitis in combination with anterior pituitary hormone deficiencies. In contrast, acute onset of isolated DI in the postpartum period is unusual.. This patient presented at 33 weeks gestation with placental abruption, prompting a cesarean delivery of twins. Immediately after delivery, she developed severe DI. The DI could be controlled with the vasopressinase-resistant 1-deamino-8-D-arginine vasopressin (DDAVP), but not with arginine vasopressin (AVP), and it resolved within a few weeks.. The aim of this study was to demonstrate that the postpartum DI in this patient was caused by the release of placental vasopressinase into the maternal bloodstream.. Cells were transiently transfected with the AVP receptor 2 (AVPR2) and treated with either AVP or DDAVP in the presence of the patient's serum collected postpartum or 10 weeks after delivery. The response to the different treatments was evaluated by measuring the activity of a cAMP-responsive firefly luciferase reporter construct. The in vitro studies demonstrate that the patient's postpartum serum disrupts activation of the AVPR2 by AVP, but not by the vasopressinase-resistant DDAVP.. Placental abruption can rarely be associated with acute postpartum DI caused by release of placental vasopressinase into the bloodstream. This clinical entity must be considered in patients with placental abruption and when evaluating patients presenting with DI after delivery.

Topics: Abruptio Placentae; Acute Disease; Adult; Antidiuretic Agents; Arginine Vasopressin; Cesarean Section; Cystinyl Aminopeptidase; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Resistance; Female; HEK293 Cells; Humans; Postpartum Period; Pregnancy