von Willebrand Disease and other hereditary haemostatic factor deficiencies in women with a history of postpartum haemorrhage

Abstract

Introduction: Postpartum haemorrhage (PPH) is the main cause of maternal morbidity and mortality globally, but it is far more important in non-developed countries.PPH represents 25% of all maternal deaths worldwide. Women with von Willebrand disease (VWD) and other inherited haemorrhagic disorders are at increased risk of PPH. Our aim was to establish a probable association of severe PPH in women with a history of haemostatic abnormalities.Methods: An observational, controlled study of adult women with a one or more episodes of severe PPH requiring treatment in an intensive care unit or >10 units of blood products during the 24-hour period after diagnosis and their controls. The tests performed were blood cell count, blood group, renal, viral, liver function and haemostatic tests, fibrinogen, activity of the plasma factors and specific test to diagnose and classify VWD. Results:We included 124 women with 133 PPH events and their controls. The median age at the first event was 25.5 years old. Results were significantly different between the groups in terms of fibrinogen concentration, VWF:Ag, VWF:RCo and FVIII. A specific diagnosis was established in 69 (55.6) and 4 (3.2%) patients in the

Blood Coagulation Indices in Twin Pregnancy Complicated with Preeclampsia

“…The coagulation and fibrinolysis systems of PE patients have experienced severe and complex changes, rather than simply increasing the procoagulant substance. 16,17 Coagulation function indicators experienced significant changes in the early pregnancy, began to show abnormalities in the middle pregnancy, and had the greatest change in the late pregnancy. These indicators showed greater changes in the severe PE group.…”

Examining international practices in the management of pregnant women with von Willebrand disease

“…7 Indeed, the occurrence of severe PPH may prompt consideration of hemostatic testing, serving as the diagnostic bleeding event for many women with VWD. 8 Following childbirth the risk of excess bleeding persists, with higher reported rates of secondary PPH (excess bleeding >24 h to 6 weeks following delivery) of up to 30% compared to 2% in the general population. 6 The clinical management of pregnant women with VWD involves both patient preference and the combined clinical input of the obstetrics, anesthetics, and hemophilia treatment center (HTC) teams.…”

“…Childbirth represents a major hemostatic challenge for women with VWD who, compared to pregnant controls, are 1.5 times more likely to develop a PPH, with a higher risk of both transfusion (5‐fold) and death (10‐fold) 7 . Indeed, the occurrence of severe PPH may prompt consideration of hemostatic testing, serving as the diagnostic bleeding event for many women with VWD 8 . Following childbirth the risk of excess bleeding persists, with higher reported rates of secondary PPH (excess bleeding >24 h to 6 weeks following delivery) of up to 30% compared to 2% in the general population 6 …”

Von Willebrand Disease—Specific Aspects in Women

“…Retrospectively, around 80% of women with PPH had clinical symptoms suggesting a hemostatic disorder, including HMB, which emphasizes the predictive role of HMB in preventing and treating PPH. 40…”