The baby is, as you say, at 50/50 risk for VWD, but not severe - only mild or mod. The OB should avoid operative vaginal delivery and scalp electrode. (No one does scalp sampling any more.) If the patient is in the third stage of labor and at a point of "no return" with fetal distress, the OB should choose forceps over vacuum, otherwise have a low threshold for C/S. Otherwise, C/S should be used for obstetric reasons only.
The OB should get two tubes of cord blood, light blue topped, so that studies can be run on the infant. Is it a girl or boy? If a boy, circumcision should be postponed until his status is known with respect to VWF/FVIII.
Andra James, MD, MPH
Director/Founder of the Women's Hemostasis and Thrombosis Clinic
Duke University Medical Center
Professor of Obstetrics & Gynecology
Duke University School of Medicine
Durham, NC
