Risk of severe hemorrhage after childbirth ‘alarmingly high’: Study

Such postpartum bleeding almost 5 times more likely with hemophilia, VWD

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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A pregnant woman holding her abdomen as she walks.

Women with hemophilia and other bleeding disorders are more likely to experience postpartum hemorrhage and other bleeding problems related to pregnancy and childbirth than those without such diseases, a population-based study from Canada reports.

Findings “showed that women with inherited bleeding disorders are at increased odds of [postpartum hemorrhage] and antepartum haemorrhage [bleeding before childbirth] during pregnancy, and alarmingly high odds of severe [postpartum hemorrhage],” the researchers wrote.

The study, “Impact of inherited bleeding disorders on maternal bleeding and other pregnancy outcomes: A population-based cohort study,” was published in the journal Haemophilia.

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Although hemophilia is less common in women than men, it’s known

Postpartum hemorrhage — extensive blood loss following childbirth — is responsible for about 1 out of every 4 pregnancy-related deaths worldwide.

People with bleeding disorders like hemophilia are thought to be at an increased risk of such hemorrhage, but there hasn’t been much research comparing postpartum hemorrhage rates among women with hemophilia or other bleeding disorders to those of the general population.

One possible reason for this lack is that hemophilia more commonly affects males than females, who are more often disease carriers. But women are known to have hemophilia A or B.

Researchers used a large healthcare database from the Canadian province of Alberta to gather and analyze data on 311,330 women who, from January 2010 to December 2018, had a total of 454,400 pregnancies that resulted in live births.

Among them, 93 women (with a total of 140 pregnancies) had bleeding disorders, including hemophilia A or B, and von Willebrand disease (VWD).

Among the overall study population, postpartum hemorrhage occurred in about 1 out of every 10 births. This rate didn’t change much over the years studied, which was notable since some other studies have reported increasing rates in the general population since the early 2000s.

“In this large Canadian population-based cohort study, we demonstrated that despite a rise in the rate of PPH [postpartum hemorrhage] between 2003 and 2010, there was no significant change in the rate of overall and primary PPH between 2010 and 2018,” the scientists wrote.

Researchers noted that, for women with bleeding disorders, postpartum hemorrhage rates appeared to increase, rising from 12.5% in 2010 to 33.3% in 2018. But this difference wasn’t statistically significant, meaning it’s mathematically plausible the change could be due to random chance.

Majority of women in study lacked a diagnosis before their pregnancy

Scientists then used statistical analyses to compare the hemorrhage risk for women with bleeding disorders with those from the overall population.

Women with hemophilia or VWD were more than twice as likely to experience a postpartum hemorrhage, and nearly five times as likely to have a severe hemorrhage, results showed.

These women also were at a significantly higher risk of having substantial bleeding before birth, an antepartum hemorrhage, and they were more likely to require a red blood cell transfusion. However, no significant differences were observed in terms of newborn outcomes, such as bleeding in the brain or low birth weight, between women with and without bleeding disorders.

Researchers noted that, in more than half (57%) of the cases, a woman’s bleeding disorder was not diagnosed prior to her pregnancy, and that there have been cases where a postpartum hemorrhage was the first documented sign of a bleeding disorder.

According to the researchers, this lack and delay of a proper diagnosis “may lead to suboptimal peripartum [before childbirth] management, resulting in preventable bleeding events.”

In pregnant women with a known bleeding disorder, it’s recommended to check levels of relevant clotting-related proteins in the third trimester in order to minimize the risk of complications like postpartum hemorrhage. But researchers found such checks were not done for many women, including for those with an established bleeding disorder diagnosis.

While it’s impossible to draw definitive conclusions about cause-and-effect from this study, the researchers said that the lack of an early diagnosis and appropriate treatment likely contributed to a higher risk of a postpartum hemorrhage for these women. They called for efforts to address these issues.

“Further study is required to identify factors associated with delayed diagnosis and inadequate [treatment to prevent bleeding] to help ensure early identification and management of underlying bleeding disorders,” the researchers wrote.