In this review, there were no other reported cases of increased uterine activity or premature labour. The effect of DDAVP on V1 receptors found in blood vessels and uterine smooth muscle is very small when compared to the naturally occurring vasopressin [41]. There were no reports of uterine hyperstimulation in the studies included in this review. Intrauterine growth retardation (IUGR) has also been a concern with use of

DDAVP in pregnancy due to potential vasopressor effect and resultant reduced placenta blood flow. However, DDAVP has very weak vasopressor activity and is generally used for a very short duration during pregnancy to cover transient bleeding risks. Thus, it is unlikely to have a significant enough effect on medium or long-term placental blood flow check details to cause IUGR. There were no cases of IUGR in the population studied in this article. Observations of uterine blood flow and vascular tone DAPT supplier show no change with intranasal DDAVP in women with intra-uterine-device-associated menorrhagia on Doppler ultrasound assessment [42]. The vasomotor side effects of DDAVP are

usually mild and transient, but include mild tachycardia, headache and flushing [35]. The dose or route of DDAVP administration did not show any strong correlation with increased risk of complications or side effects. There was no evidence found to support an increased risk of pre-eclampsia or thromboembolic events as a result of treatment with DDAVP [6,15]. There are no robust data on the use of DDAVP with a breast-feeding infant but it is known that DDAVP is released in breast milk in very small quantities [43]. Coupled with negligible oral absorption, there is unlikely to be significant transfer of DDAVP to an infant from breast-feeding [44]. However, the manufacturer still recommends against the use of DDAVP during breast feeding [45]. The use of DDAVP in pregnancy with good safety profile echoes a previously published systematic review of intranasal DDAVP use

in pregnant women with diabetes insipidus [6]. No structural abnormalities were observed in foetuses exposed to DDAVP during the first trimester. In vitro models of placentae do not show DDAVP crossing the placental barrier in detectable amounts, which also provides Aldehyde dehydrogenase support for the safe use of DDAVP with regard to foetal outcome. No other adverse neonatal outcome has been attributable to DDAVP use [6,15]. In conclusion, there is a growing volume of data regarding the safe use of DDAVP in pregnancy. It appears to be a safe and effective measure for the prevention or treatment of bleeding episodes in pregnant women with various bleeding disorders. Safe use can be achieved by avoiding water overload and appropriate dosing of DDAVP. It is important that pregnant women with bleeding disorders are cared for by a multidisciplinary team of Obstetricians, Haematologists and Anaesthetists to optimize maternal and neonatal outcomes.