Pregnancy-Associated Bleeding in Carriers and Women with Hemophilia
Written by: David Clark, PhD, chair of the Coalition for Hemophilia B
Two studies from 2020 looked at bleeding complications during and after pregnancy in women with bleeding disorders and hemophilia carriers.
One study from the United Kingdom looked at postpartum bleeding in carriers and women with bleeding disorders between 2008 and 2017, including 16 A carriers, 8 B carriers, 8 factor XI-deficient patients, and 14 with von Willebrand disease. None of the A or B carriers received factor around the time of delivery. The study found that women with bleeding disorders had a significantly higher risk of bleeding during the primary postpartum period (within 24 hours after delivery), despite being managed according to current guidelines. (1)
Further investigation is warranted to help improve the experiences of women with bleeding disorders giving birth.
A second study from seven French hemophilia treatment centers between 2014 and 2019 looked at 104 carriers (A or B) and 119 neonates representing 124 pregnancies and 117 deliveries. The researchers observed 35 bleeding episodes, 83% of which occurred during the postpartum period; 37% of the postpartum bleeds occurred during the secondary postpartum period, which is from 24 hours to 12 weeks after delivery. Three of the neonates suffered cerebral hemorrhages. Caesarean delivery was associated with more postpartum bleeding, and women with factor levels less than 40% were at higher risk of bleeding during the secondary postpartum period. (2)
Both groups stress that their results warrant further investigation to help improve the experiences of women with bleeding disorders giving birth.
REFERENCES
S. Wolf et al., Postpartum bleeding in women with inherited bleeding disorders: a matched cohort study, Blood Coagulation and Fibrinolysis 31(7), October 2020. Abstract.
A. Nau et al., Bleeding complications during pregnancy and delivery in haemophilia carriers and their neonates in Western France: An observational study, Haemophilia, August 25, 2020. Abstract.