Planning Pregnancy and Birth in Women with Inherited Bleeding Disorders

Abstract

Inherited bleeding disorders are characterized by a diverse clinical phenotype within and across specific diagnoses. von Willebrand disease (VWD), hemophilia A, and hemophilia B comprise 95 to 97% of inherited bleeding disorders, with the remaining 3 to 5% attributed to rare bleeding disorders, including congenital fibrinogen disorders, factor deficiencies (affecting FII, FV, FV + FVIII, FVII, FX, FXI, and FXIII), and platelet function defects. The pregnancy, birth, and the puerperium may be adversely influenced in the setting of an inherited bleeding disorder depending on its type and clinical phenotype. Obstetric hemostatic challenges may sometimes also unmask the presence of a previously unknown inherited bleeding disorder. This review aims to address the approach to pregnancy and birth in the context of an inherited bleeding disorder and highlights the significance of multidisciplinary input into the care of these women.

How to investigate mild to moderate bleeding disorders and bleeding disorder of unknown cause

“…The Vienna Bleeding Biobank indicated a significant incidence of postpartum hemorrhage in women with MBD, as reported by 34.2% of women who gave birth overall, and 31.9% of women with BDUC, in line with the RBiN study 13,15 . Obstetrical history should include the type of delivery, the modality of anesthesia and the hemostatic treatment received 16 . To document bleeding outcomes following hemostatic challenges in the context of MBD, inquiries must specifically address the type of surgery, the bleeding character, procedure/anesthesia time, use of hemostatic interventions, and wound healing.…”

“…13,15 Obstetrical history should include the type of delivery, the modality of anesthesia and the hemostatic treatment received. 16 To document bleeding outcomes following hemostatic challenges in the context of MBD, inquiries must specifically address the type of surgery, the bleeding character, procedure/ anesthesia time, use of hemostatic interventions, and wound healing.…”

2024 Eberhard F. Mammen Award Announcements: Part I—Most Popular Articles

“…Consequently, the most popular papers from each category are identified separately. Tables 3 and 4 respectively list the top 25 downloaded articles from STH in 2023 (from 2022 and 2023 inclusive), as eligible for either the “free access” ( Table 3 ) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 or “general category” ( Table 4 ) 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 awards.…”

“…The publisher of STH, Thieme, had in the past provided most material related to COVID-19 as free to download, and so COVID19-related material is less likely to be itemized in the “general category” list of most popular. 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 The 25 most popular non-free to download papers are listed in Table 4 . The first two papers listed are the official winners of the 2024 Most Popular in the general category.…”

Maternal and Neonatal Hemostasis

“…The article by Malinowski and Abdul-Kadir 7 addresses the issues of bleeding during pregnancy and around delivery in women with inherited rare bleeding disorders (RBDs). Obstetric challenges may sometimes unmask the presence of a previously unknown bleeding disorder, and certainly among women with a known inherited RBD, gestation, labor, and puerperium may be adversely influenced.…”