The total blood loss, red blood cell transfusion requirement and progression to severe PPH were significantly reduced in the women who received TA compared to the control group [44]. A further, large multinational randomized trial is currently enrolling [World Maternal Antifibrinolytic (WOMAN) Trial] to investigate the impact of TA administration (1 g IV) on the selleck kinase inhibitor rate of hysterectomy and mortality in women with PPH [45]. A major concern among clinicians

still exists about the prolonged use of TA in women during pregnancy because of the possible increased risk of thromboembolism. Indeed, TA inhibits fibrinolysis and carries a potential risk of thrombosis especially in high risk patients. Therefore prolonged use of TA is not recommended in pregnancy and its use is contraindicated in women with previous history of thromboembolism. Other adverse effects of TA are minor and include nausea or diarrhoea and sometimes, orthostatic reactions. More importantly, no mutagenic activities of TA and no foetal abnormalities were identified in early studies in animals: also excretion in breast milk is low and

therefore TA can be used safely in lactating women [39]. 1-deamino-8-D-arginine vasopressin is a synthetic analogue of vasopressin. DDAVP increases VWF and FVIII plasma concentrations without important side effects when administered to healthy volunteers or patients with mild haemophilia A (HA) and VWD. DDAVP has been widely used for the treatment of these diseases for over 30 years [46]. DDAVP is Caspase inhibitor review most effective in patients with mild forms of type 1 VWD, especially those who have normal VWF in storage sites. It is ineffective in type 3 VWD and contraindicated in type 2B VWD,

because of the transient appearance of thrombocytopenia [47]. DDAVP has also been proven to be effective in patients with mild-moderate HA: their clinical response seems to correlate with age, baseline FVIII levels and genotype [48]. A systematic review on the use of DDAVP during pregnancy, delivery and postpartum was recently performed by Trigg et al. [49]. DDAVP was used successfully during the first and second trimester in 51 pregnancies for prevention of bleeding prior to invasive PND procedures with no reported neonatal complications. Maternal side effects associated with DDAVP were generally mild and included facial flushing DOCK10 and headache. The most common indication for use of DDAVP was the prevention of PPH in women with IBD. Of the 172 pregnancies that received DDAVP prophylaxis, no significant bleeding complications were reported in 167 deliveries, without any premature births or neonatal complications [49]. Concerns about DDAVP use in pregnancy are mainly due to the very few cases complicated by seizure secondary to the water intoxication observed in the postpartum period. Safe use can be achieved by avoiding water overload and appropriate dosing of DDAVP with no more than 1–2 injections per day.