Is primary postpartum haemorrhage a good predictor of inherited bleeding disorders?

Kadir, Rezan A.; Kingman, C. E. C.; Chi, Claudia; Lee, C. A.; Economides, D. L.

doi:10.1111/j.1365-2516.2006.01413.x

Cited by 10 publications

(12 citation statements)

References 17 publications

(20 reference statements)

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“…21 Furthermore, we found that the majority of women was diagnosed with low VWF or mild VWD type 1 (9/16, 56%). In line with our results, one study also mentioned the value of a Bleeding Assessment Tool, as the only woman diagnosed with a bleeding disorder was also the only patient who reported more than two additional bleeding symptoms.…”

Section: Discussionmentioning

confidence: 72%

“…21 In contrast to our study, this study included women with blood loss of ≥500 mL for spontaneous vaginal deliveries, ≥700 mL for instrumental deliveries and ≥1000 mL for caesarian sections, to define a group of women more likely to have abnormal coagulation. 21 In contrast to our study, this study included women with blood loss of ≥500 mL for spontaneous vaginal deliveries, ≥700 mL for instrumental deliveries and ≥1000 mL for caesarian sections, to define a group of women more likely to have abnormal coagulation.…”

Section: Discussionmentioning

confidence: 99%

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Severe postpartum haemorrhage as first presenting symptom of an inherited bleeding disorder

et al. 2019

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Introduction:Postpartum haemorrhage (PPH) is the major cause of maternal death worldwide. Haemostatic abnormalities are independently associated with a significantly increased risk for severe PPH. In this study, the value of haemostatic evaluation in women with severe PPH was explored.Aim: To investigate the occurrence of previously unknown inherited bleeding disorders in women with severe PPH.Methods: Women with severe PPH (blood loss of ≥2000 mL) between 2011 and 2017, referred to the haematology outpatient clinic for haemostatic evaluation, were retrospectively included. A bleeding disorder was diagnosed based on (inter)national guidelines, or when having a clear bleeding phenotype, not fulfilling any diagnostic criteria or laboratory abnormalities, this being classified as Bleeding of Unknown Cause (BUC). Logistic regression was used to model the association between diagnosis and obstetrical causes and risk factors for PPH. Results:In total, 85 women with PPH were included. In 23% (n = 16), a mild bleeding disorder was diagnosed, including low von Willebrand factor (Low VWF 8/16), platelet function disorders (PFD 5/16), BUC (2/16) and von Willebrand disease type 1 (1/16). No significant associations were found between obstetrical causes or risk factors for PPH and the presence of a bleeding disorder. Conclusion:In 23% of women with severe PPH, a mild bleeding disorder was diagnosed, independent of obstetrical causes or risk factors for PPH. This implies that severe PPH can be the first clinical symptom of an inherited bleeding disorder. Therefore, to optimize clinical management, haemostatic evaluation after severe PPH is recommended. K E Y W O R D Shaemostasis, inherited blood coagulation disorders, postpartum haemorrhage, von Willebrand disease, women's health

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Severe postpartum haemorrhage as first presenting symptom of an inherited bleeding disorder

et al. 2019

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“…PPH is multifactorial in nature and the prevalence of undiagnosed bleeding disorders in women presenting with PPH is unknown. In a study of 50 women with primary PPH screened for underlying bleeding disorders (VWD and FXI deficiency) 3 to 9 months after delivery, only one woman was diagnosed with VWD, suggesting that primary PPH is not a helpful discriminator to screen for these bleeding disorders . Further larger studies are required to fully answer this question.…”

Section: Inherited Bleeding Disordersmentioning

confidence: 99%

“…In a study of 50 women with primary PPH screened for underlying bleeding disorders (VWD and FXI deficiency) 3 to 9 months after delivery, only one woman was diagnosed with VWD, suggesting that primary PPH is not a helpful discriminator to screen for these bleeding disorders. 39 Further larger studies are required to fully answer this question. Bleeding assessment tools, [40][41][42] which catalog the bleeding history of patients to evaluate the likelihood of an underlying bleeding disorder have not yet been validated in women who have experienced PPH.…”

Section: Can Pph Be An Indicator Of An Unidentified Bleeding Disorder?mentioning

confidence: 99%

Evaluation and management of postpartum hemorrhage: consensus from an international expert panel

et al. 2014

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“…12, 22–24 Other congenital coagulation disorders, including Factor II, VII, X, XI deficiencies and carriage of hemophilia A and B are rare, but have also been associated with excess bleeding with delivery. 12, 24–26 While based on small studies, the prevalence of undiagnosed coagulation disorders in the general population of patients with PPH is low, 27, 28 and further study is needed to ascertain whether this may not pertain to the population of women that experience recurrent PPH.…”

Section: Commentmentioning

confidence: 99%

Patterns of recurrence of postpartum hemorrhage in a large population-based cohort

Öberg

Hernández–Dı́az

Palmsten

et al. 2014

American Journal of Obstetrics and Gynecology

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Objectives While a history of postpartum hemorrhage (PPH) is a recognized risk factor for PPH in subsequent pregnancies, little is known about how the risk accumulates over multiple pregnancies, how recurrence varies by PPH subtype, and whether recurrence can be explained by chronic maternal conditions. Study design Risks of PPH were assessed according to prior history of PPH, severity and subtype (atony, retained placenta, or lacerations) in 538 332 primiparous women included in the Swedish Medical Birth Register between 1997–2009. The role of stable maternal risk factors was evaluated in regression models predicting probability of recurrent PPH in 2nd and 3rd pregnancy. Results Women with a previous history of PPH had a 3-fold increased risk of PPH in their second pregnancy compared to unaffected women (15.0% vs. 5.0% respectively). Adjustment for stable maternal risk factors did not significantly attenuate this risk (adjusted relative risk: 3.0, 95% confidence interval 2.9–3.1). In third pregnancy, the risk of PPH was 26.6% after two previously affected pregnancies, compared to 4.4% in women with no previous PPH. A history of a specific type of PPH predicted recurrence of PPH in the second pregnancy, not only of the same type but other etiologies as well. Conclusions PPH risk is highest among women with >1 previously affected delivery and in those with a previous severe PPH. Chronic conditions known to be risk factors for PPH do not explain the recurrence risks. The recurrence patterns across PPH subtypes may point to shared pathological mechanisms underlying the varying PPH etiologies.

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Is primary postpartum haemorrhage a good predictor of inherited bleeding disorders?

Cited by 10 publications

References 17 publications

Severe postpartum haemorrhage as first presenting symptom of an inherited bleeding disorder

Severe postpartum haemorrhage as first presenting symptom of an inherited bleeding disorder

Evaluation and management of postpartum hemorrhage: consensus from an international expert panel

Patterns of recurrence of postpartum hemorrhage in a large population-based cohort

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