In a recent publication in the journal Haemophilla, researchers conducted a population-based retrospective cohort study and sought to characterize trends in postpartum hemorrhage (PPH) in the last decade, to evaluate the impact of inherited bleeding disorders on pregnancy outcomes, and to assess their coagulation workup during pregnancy.
The researchers utilized data from the Alberta Pregnancy Birth Cohort from January 2010 to December 2018. Using a previously validated algorithm and matched with controls, the researchers identified and included women diagnosed with von Willebrand disease (VWD) and hemophilia. To compute the odds of PPH and other pregnancy outcomes, logistic regression was employed.
Study participants were allocated to one of two groups, including 1) pregnancies in women with VWD, hemophilia A, and hemophilia B identified utilizing combined ICD diagnostic codes and laboratory criteria and 2) pregnancies in women without inherited bleeding disorders. The control group was comprised of pregnant women without ICD codes for any inherited bleeding disorders during the study period.
The study population included 311,330 women, with 454,400 pregnancies with live births. The average age of mothers was 29.6 years. Within this population, 80 women were identified as having VWD, 11 women with hemophilia A, and two women with hemophilia B.
The results revealed that over the study period, the rate of PPH did not demonstrate a substantial change overall (P = .35). In 2010, this rate was 10.13 per 100 deliveries (95% CI, 10.10-10.16), and in 2018, the rate was 10.72 (95% CI, 10.69-10.75). However, significant variances were observed in the rates of PPH established on the incidence of any of the evaluated bleeding disorders. The results also revealed that compared with those women without bleeding disorders, women with bleeding disorders were meaningfully more likely to experience PPH (odds ratio [OR] 2.3; 95% CI 1.5-3.6), antepartum hemorrhage (OR 2.9; 95% CI 1.5-5.9), and red cell transfusion (OR 2.8; 95% CI 1.1-7.0).
The researchers wrote, “We observed a nonsignificant rise in the rate of PPH in women with VWD and hemophilia. Only 49.5% of pregnancies with bleeding disorders had third-trimester coagulation factor levels checked. Higher odds of PPH and antepartum hemorrhage were observed even with factor levels ≥0.50 IU/mL in the third trimester.”
Based on their findings, the authors concluded that PPH occurred at a persistent rate during the study period, but women with inherited bleeding disorders were at greater risk of adverse outcomes such as PPH and antepartum hemorrhage during pregnancy when compared with the study population controls. The results also revealed that there were also alarmingly elevated odds of severe PPH and secondary PPH. Additionally, in this study, the researchers noted that during the third trimester for women with bleeding disorders, the rates of hemostasis workup were suboptimal, even in women with a preexisting diagnosis of inherited bleeding disorders.
Lastly, they wrote, “Further study is required to identify factors associated with delayed diagnosis and inadequate hemostasis workup to help ensure early identification and management of underlying bleeding disorders.”
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