Postpartum Hemorrhage in Women with Bleeding Disorders

By Dr. David Clark

Postpartum Hemorrhage in Women with Bleeding Disorders 

1/24/24  Postpartum hemorrhage (PPH: bleeding after giving birth) causes almost one-quarter of all maternal deaths worldwide and is the leading cause of maternal mortality in both low-income and developed countries.  Women with bleeding disorders like hemophilia and von Willebrand disease are at increased risk.  A group of researchers in Alberta, Canada looked at all births in the province between 2010 and 2018 (311,330 women with a total of 454,400 pregnancies that resulted in live births). 

They found that women with bleeding disorders had about 2.3 times the risk of PPH than did the women without bleeding disorders.  They also had about 4.7 times higher risk of severe PPH. In addition, the women with bleeding disorders had about 2.9 times the risk of antepartum hemorrhage (bleeding during pregnancy, before giving birth) and received about 2.8 times more blood transfusions.  There was a higher risk of PPH, even for women with factor levels above 50%. 

The startling fact is that only about half (49.5%) of the women with bleeding disorders had their factor levels checked during the third trimester before birth.  This was the case whether the women had a previous diagnosis of a bleeding disorder or not.  However, there were no significant differences between women with bleeding disorders and those without when it came to the baby’s survival and health. 

The authors conclude that in spite of comprehensive care in women with bleeding disorders, they are still at increased risk of adverse pregnancy outcomes compared to women without bleeding disorders.  [Alam AUI et al., Haemophilia, 30:478-489, 2024]