Primary postpartum haemorrhage in women with von Willebrand disease or carriership of haemophilia despite specialised care: a retrospective survey

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Primary postpartum haemorrhage in women with von Willebrand disease or carriership of haemophilia despite specialised care: a retrospective surveyS. C. M. Stoof1, H. W. van Steenbergen2, A. Zwagemaker3, Y. V. Sanders1, S. C. Cannegieter4, J. J. Duvekot5, F. W. G. Leebeek1, M. Peters3, M. J. H. A. Kruip1 andJ. Eikenboom2,6,*Article first published online: 16 FEB 2015

DOI: 10.1111/hae.12635

© 2015 John Wiley & Sons Ltd

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HaemophiliaEarly View (Online Version of Record published before inclusion in an issue)

Additional Information

How to CiteStoof, S. C. M., van Steenbergen, H. W., Zwagemaker, A., Sanders, Y. V., Cannegieter, S. C., Duvekot, J. J., Leebeek, F. W. G., Peters, M., Kruip, M. J. H. A. and Eikenboom, J. (2015), Primary postpartum haemorrhage in women with von Willebrand disease or carriership of haemophilia despite specialised care: a retrospective survey. Haemophilia. doi: 10.1111/hae.12635

Author Information1

Department of Haematology, Erasmus University Medical Centre, Rotterdam, The Netherlands

2

Department of Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, The Netherlands

3

Department of Paediatric Haematology, Academic Medical Centre, Amsterdam, The Netherlands

4

Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands

5

Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands

6

Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Centre, Leiden, The Netherlands

* Correspondence: Jeroen Eikenboom, MD, PhD, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands.
Tel.: +31 71 5261893; fax: +31 71 5266868;
e-mail: h.c.j.eikenboom@lumc.nl

Publication HistoryArticle first published online: 16 FEB 2015Manuscript Accepted: 8 DEC 2014 SEARCH Search Scope All contentPublication titlesIn this journalIn this issue Search String Advanced >Saved Searches > SEARCH BY CITATION Volume: Issue: Page: ARTICLE TOOLSGet PDF (300K)Save to My ProfileE-mail Link to this ArticleExport Citation for this ArticleGet Citation AlertsRequest Permissions AbstractArticleReferencesSupporting InformationCited By View Full Article with Supporting Information (HTML) Enhanced Article (HTML) Get PDF (300K) Keywords:delivery;haemophilia A;haemophilia B;postpartum haemorrhage;prophylactic replacement therapy;von Willebrand diseaseSummary

Pregnant women with bleeding disorders require specialised peripartum care to prevent postpartum haemorrhage (PPH). If third trimester coagulation factor levels are <0.50 IU mL-1, prophylactic treatment is indicated and administered according to international guidelines. However, optimal dose and duration are unknown and bleeding may still occur. The aim of this study was to investigate the outcome in women with von Willebrand disease (VWD) or haemophilia carriership treated according to current practice guidelines. From the period 2002–2011, 185 deliveries in 154 VWD women or haemophilia carriers were retrospectively included. Data on blood loss, bleeding disorder characteristics and obstetric risk factors were obtained. The outcome was primary PPH, defined as blood loss =500 mL within 24 h postpartum and severe PPH as blood loss =1000 mL. Primary PPH was observed in 62 deliveries (34%), 14 (8%) of which resulted in severe PPH. In 26 deliveries prophylactic treatment was administered due to factor levels below the 0.50 IU mL-1 cut-off in the third trimester, 14 of which (54%) were complicated by PPH. We found an increased PPH risk in deliveries given prophylactic treatment compared with deliveries without (OR 2.7, 95% CI 1.2–6.3). In conclusion, PPH incidence was highest in deliveries with the lowest factor levels in the third trimester. Currently, delivery outcome in women with bleeding disorders is unsatisfactory, given the high PPH incidence despite specialised care. Future studies are required to optimise management of deliveries in this patient population.

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