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Pregnancy, childbirth and neonatal outcomes in women with inherited bleeding disorders: a retrospective analysis.
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  • Lisa Clarke,
  • Jennifer Curnow,
  • Briony Cutts,
  • Bryony Ross,
  • Giselle Kidson-Gerber
Lisa Clarke
Sydney Adventist Hospital Ltd
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Jennifer Curnow
Westmead Hospital
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Briony Cutts
Royal Women's Hospital Department of Obstetrics and Gynaecology
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Bryony Ross
Calvary Mater Newcastle
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Giselle Kidson-Gerber
Prince of Wales Hospital and Community Health Services
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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.

Peer review status:UNDER REVIEW

18 Jun 2021Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
19 Jun 2021Assigned to Editor
19 Jun 2021Submission Checks Completed
21 Jun 2021Reviewer(s) Assigned