Pregnancy, childbirth and neonatal outcomes in women with inherited
bleeding disorders: a retrospective analysis.
Abstract
Objective To describe the characteristics and outcomes of women with
inherited bleeding disorder during pregnancy and birth. Design
Retrospective cohort study. Setting Tertiary care hospitals, NSW and
Victoria Australia. Population 100 women with inherited bleeding
disorders, who birthed 134 live infants from 132 pregnancies. Methods
Data was retrospectively obtained from the patient and neonatal medical
records. Descriptive analysis was used to report maternal and pregnancy
characteristics, birth and neonatal outcomes. Main outcome measures
Factor replacement, neuraxial analgesia use and complications,
post-partum haemorrhage and neonatal complications. Results PPH occurred
in 22% of deliveries with primary PPH occurring in 20% and secondary
PPH in 4% of births. 48% of PPHs were classified as major. PPHs
occurred across the spectrum of IBD and was evenly distributed between
women who had “normalised” their factor levels in pregnancy compared
to those requiring factor at the time of birth. An obstetric cause was
identified in more than half of PPHs. Conclusions Women with inherited
bleeding disorders can deliver safely and receive neuraxial analgesia
without complication when best practices are adhered to. PPH appears to
occur at higher rates than the general population despite adequate
factor levels or planned replacement. Whilst an obstetric cause was
demonstrable in the many cases, these findings raise concern over the
current definition of “adequate” factor levels at the time of birth.