1
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Pregnancy, childbirth and neonatal outcomes of women with rare inherited coagulation disorders. Obstet Med 2023. [DOI: 10.1177/1753495x221148813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background We aimed to describe the characteristics and the pregnancy outcomes of women with rare inherited coagulation factor disorders managed at a tertiary obstetric-haematology unit in the United Kingdom. Methods A retrospective service evaluation was conducted using routinely collected medical records. Descriptive analyses were applied to investigate pregnancy, childbirth and neonatal management and outcomes. Results Overall, 20 patients with rare inherited coagulation disorders were included who birthed 30 live infants from 29 pregnancies. Regarding maternal bleeding outcomes, 3% experienced antepartum haemorrhage, 38% of pregnancies experienced primary post-partum haemorrhage, and none experienced secondary post-partum haemorrhage. Five (17%) neonates had cranial ultrasound scans for imaging to investigate for a neonatal haemorrhage, which were all normal. Conclusions Although women with rare inherited coagulation disorders may be more susceptible to complications in pregnancy, within this cohort there was no evidence that the condition led to increased morbidity or mortality when best practices were observed.
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2
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Shirzadi M, Radfar AH, Dehghani M. Recurrent miscarriage in a woman with congenital factor V deficiency: a case report. BMC Pregnancy Childbirth 2022; 22:915. [PMID: 36482349 PMCID: PMC9732993 DOI: 10.1186/s12884-022-05273-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Factor V deficiency is a rare bleeding disorder that can be either congenital or acquired. Factor V deficiency mostly present with mucosal bleeding. Coagulation factor V does not increase considerably during normal gestation. Since pregnancy can be threatened by blood clotting disorders, abnormal changes in coagulation factors level can pose challenges to pregnant women. CASE PRESENTATION We report a 40-year-old pregnant woman with prolonged gingival bleeding and epistaxis at 28 weeks of pregnancy. Her past medical history included two unexplained abortions. Physical examination was unremarkable, but the blood test showed elevated PT and PTT with a considerable decrease in factor V activity, while other factors were within normal range. Subsequently, the patient was diagnosed with congenital factor V deficiency. After treatment with fresh frozen plasma, she underwent vaginal delivery and a baby with factor V deficiency was born. CONCLUSIONS This is the second report of recurrent miscarriage in congenital factor V deficiency patients. Clinicians should consider the possibility of factor V deficiency in women with a history of idiopathic miscarriage even in patients without any symptoms.
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Affiliation(s)
- Mohammad Shirzadi
- grid.411036.10000 0001 1498 685XDepartment of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Hossein Radfar
- grid.411036.10000 0001 1498 685XSchool of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Dehghani
- grid.411036.10000 0001 1498 685XSchool of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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3
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Malinowski AK, Abdul-Kadir R. Planning Pregnancy and Birth in Women with Inherited Bleeding Disorders. Semin Thromb Hemost 2022; 49:371-381. [PMID: 36368690 DOI: 10.1055/s-0042-1758117] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AbstractInherited bleeding disorders are characterized by a diverse clinical phenotype within and across specific diagnoses. von Willebrand disease (VWD), hemophilia A, and hemophilia B comprise 95 to 97% of inherited bleeding disorders, with the remaining 3 to 5% attributed to rare bleeding disorders, including congenital fibrinogen disorders, factor deficiencies (affecting FII, FV, FV + FVIII, FVII, FX, FXI, and FXIII), and platelet function defects. The pregnancy, birth, and the puerperium may be adversely influenced in the setting of an inherited bleeding disorder depending on its type and clinical phenotype. Obstetric hemostatic challenges may sometimes also unmask the presence of a previously unknown inherited bleeding disorder. This review aims to address the approach to pregnancy and birth in the context of an inherited bleeding disorder and highlights the significance of multidisciplinary input into the care of these women.
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Affiliation(s)
- A. Kinga Malinowski
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
| | - Rezan Abdul-Kadir
- Department of Obstetrics and Gynaecology and Katharine Dormandy Haemophilia and Thrombosis Centre, The Royal Free NHS Foundation Hospital, London, United Kingdom
- Institute for Women's Health, University College London, London, United Kingdom
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4
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How I manage pregnancy in women with Glanzmann thrombasthenia. Blood 2022; 139:2632-2641. [PMID: 35286390 DOI: 10.1182/blood.2021011595] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/02/2022] [Indexed: 11/20/2022] Open
Abstract
Glanzmann thrombasthenia (GT) is a rare inherited platelet function disorder caused by a quantitative and/or qualitative defect of the αIIbβ3 integrin. Pregnancy and delivery is a recognized risk period for bleeding in women with GT. The newborn may also be affected by fetal and neonatal immune thrombocytopenia induced by the transplacental passage of maternal anti-αIIbβ3 antibodies, which can lead to severe hemorrhage and fetal loss. Pregnancy in GT women thus requires a multidisciplinary approach, including prepregnancy counseling, and a treatment plan for delivery for both the mother and child. In this article, we summarize the current knowledge on pregnancy in women with GT and describe how we manage this severe platelet disorder in our clinical practice.
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5
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Rodrigues-Martins D, Buchner G, Braga JS. Symptomatic haemophilia A: management during pregnancy and the postpartum period. BMJ Case Rep 2022; 15:e245474. [PMID: 34996767 PMCID: PMC8744121 DOI: 10.1136/bcr-2021-245474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 11/04/2022] Open
Abstract
As an X linked disorder, the presence of severe symptomatic haemophilia A is an extremely rare disorder in women. Therefore there are no high-level evidence-based guidelines when it comes to pregnancy. Although there have been advances in the fields of prenatal counselling and maternal-fetal care, the management of these gestations continues to embody a challenge for any medical team. We report the successful management of a pregnant woman with symptomatic haemophilia A, from pregnancy to the postpartum period. Our aim is to enhance knowledge on this topic, and further improve outcomes for these mothers and their offspring.
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Affiliation(s)
- Diana Rodrigues-Martins
- Department of Women and Reproductive Medicine, Centro Hospitalar Universitário do Porto EPE Centro Materno-Infantil do Norte Dr Albino Aroso, Porto, Portugal
- Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal
| | - Graça Buchner
- Department of Women and Reproductive Medicine, Centro Hospitalar Universitário do Porto EPE Centro Materno-Infantil do Norte Dr Albino Aroso, Porto, Portugal
| | - Jorge Sousa Braga
- Department of Women and Reproductive Medicine, Centro Hospitalar Universitário do Porto EPE Centro Materno-Infantil do Norte Dr Albino Aroso, Porto, Portugal
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6
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Dupervil B, Abe K, O'Brien SH, Oakley M, Kulkarni R, Thornburg CD, Byams VR, Soucie JM. Characteristics, complications, and sites of bleeding among infants and toddlers less than 2 years of age with VWD. Blood Adv 2021; 5:2079-2086. [PMID: 33877293 PMCID: PMC8095137 DOI: 10.1182/bloodadvances.2020004141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/23/2021] [Indexed: 11/20/2022] Open
Abstract
Data on infants and toddlers (ITs) with von Willebrand disease (VWD) are lacking. We used data collected in the US Hemophilia Treatment Center Network (USHTCN) to describe birth characteristics, bleeding episodes, and complications experienced by 105 patients with VWD who were <2 years of age. In 68% of the patients, the reason for diagnostic testing was a family history of a bleeding disorder. The mean age at diagnosis was 7 months, with little variation by sex. Patients with type 2 VWD were diagnosed earlier than those with types 1 or 3 (P = .04), and those with a family history were diagnosed ∼4 months earlier than those with none (P < .001). Among the patients who experienced a bleeding event (70%), oral mucosa was the most common site of the initial bleeding episode (32%), followed by circumcision-related (12%) and intracranial/extracranial bleeding (10%). Forty-one percent of the initial bleeding events occurred before 6 months of age, and 68% of them occurred before the age of 1 year. Approximately 5% of the cohort experienced an intracranial hemorrhage; however, none was associated with delivery at birth. Bleeding patterns and rates were similar by sex (P = .40) and VWD type (P = .10). Forty-seven percent were treated with plasma-derived von Willebrand factor VIII concentrates. The results of this study indicate that a high percentage of ITs diagnosed with VWD and receiving care within the multidisciplinary structure of the USHTCN have a family history of VWD. In addition, bleeding events such as circumcision-related, oropharyngeal, and intracranial or extracranial episodes are common and are leading indicators for treatment.
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Affiliation(s)
- Brandi Dupervil
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Karon Abe
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sarah H O'Brien
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Meredith Oakley
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Roshni Kulkarni
- Centers for Bleeding and Clotting Disorders, Department of Pediatrics and Human Development, Michigan State University, East Lansing, MI
| | - Courtney D Thornburg
- Hemophilia and Thrombosis Treatment Center, Rady Children's Hospital San Diego, San Diego, CA; and
- Department of Pediatrics, UC San Diego School of Medicine, La Jolla, CA
| | - Vanessa R Byams
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - J Michael Soucie
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
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7
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Nau A, Gillet B, Guillet B, Beurrier P, Ardillon L, Cussac V, Guillou S, Raj L, Trossaërt M, Horvais V, Bayart S, Potin J, Rose J, Macchi L, Couturaud F, Lacut K, Pan-Petesch B. Bleeding complications during pregnancy and delivery in haemophilia carriers and their neonates in Western France: An observational study. Haemophilia 2020; 26:1046-1055. [PMID: 32842170 DOI: 10.1111/hae.14117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/25/2020] [Accepted: 07/13/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pregnancy, delivery and the postpartum period expose haemophilia carriers, as well as their potentially affected neonates to a high risk of haemorrhagic complications. OBJECTIVES To describe bleeding complications in haemophilia carriers and their newborns throughout pregnancy and postpartum and to identify potential factors increasing the risk of bleeding in this population. PATIENTS/METHODS The ECHANGE multicentre observational cohort study was conducted between January 2014 and February 2019 using the BERHLINGO database comprised of patients from seven French haemophilia centres. RESULTS During the 5 years study period, a total of 104 haemophilia carriers and 119 neonates were included, representing 124 pregnancies and 117 deliveries. Thirty-five (30%) bleeding events were observed, most of them (83%) occurred during the postpartum period, and 37% were reported during the secondary postpartum. Neuraxial anaesthesia was not complicated by spinal haematoma. Three (2.5%) neonates experienced cerebral bleeding. Caesarean section was associated with an increased risk of maternal bleeding in primary and secondary postpartum periods. Basal factor level <0.4 IU/mL was also found to be associated with an increased risk of bleeding during secondary postpartum. CONCLUSION In our cohort, bleeding events occurred in more than a third of haemophilia carriers mainly in the postpartum period, and a significant portion of this bleeding occurred during the secondary postpartum. Haemophilia carriers warrant specific attention during primary and secondary postpartum, in particular in case of caesarean section and low basal factor level. The ECHANGE study is registered at clinicaltrials.gov identifier: NCT03360149.
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Affiliation(s)
- Alice Nau
- Département de Médecine Interne, Pneumologie et Médecine Vasculaire, CHU Brest, Brest, France
| | - Benjamin Gillet
- Centre de traitement de l'hémophilie, CHU Hôtel-Dieu Nantes, Nantes, France
| | - Benoît Guillet
- Centre de traitement des maladies hémorragiques, CHU Rennes, Rennes, France.,INSERM, U1085, IRSET, Université Rennes 1, Rennes, France
| | | | - Laurent Ardillon
- Service d'hématologie - hémostase, Hôpital Trousseau, CHU Tours, Tours, France
| | | | - Sophie Guillou
- Service d'hématologie biologique, CHU Poitiers, Poitiers, France.,INSERM, U1082, IRTOMIT, Université de Poitiers, Poitiers, France
| | - Leela Raj
- EA3878, Université de Bretagne Occidentale, Brest, France
| | - Marc Trossaërt
- Centre de traitement de l'hémophilie, CHU Hôtel-Dieu Nantes, Nantes, France
| | - Valérie Horvais
- Centre de traitement de l'hémophilie, CHU Hôtel-Dieu Nantes, Nantes, France
| | - Sophie Bayart
- Centre de traitement des maladies hémorragiques, CHU Rennes, Rennes, France
| | - Jérôme Potin
- Service d'obstétrique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Johan Rose
- Laboratoire d'hématologie, CH Le Mans, Le Mans, France
| | - Laurent Macchi
- Service d'hématologie biologique, CHU Poitiers, Poitiers, France.,INSERM, U1082, IRTOMIT, Université de Poitiers, Poitiers, France
| | - Francis Couturaud
- Département de Médecine Interne, Pneumologie et Médecine Vasculaire, CHU Brest, Brest, France.,EA3878, Université de Bretagne Occidentale, Brest, France
| | - Karine Lacut
- Département de Médecine Interne, Pneumologie et Médecine Vasculaire, CHU Brest, Brest, France.,EA3878, Université de Bretagne Occidentale, Brest, France
| | - Brigitte Pan-Petesch
- EA3878, Université de Bretagne Occidentale, Brest, France.,Centre de traitement des maladies hémorragiques, Hémostase clinique, Service d'hématologie clinique, CHU Brest, Brest, France
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8
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Lavin M, Horan M, Durand O'Connor A, Doherty D, Manning C, Lynch C, Regan C, Ryan K, Byrne B. The impact of foetal restrictions on mode of delivery in women with inherited bleeding disorders. Eur J Haematol 2020; 105:555-560. [PMID: 32602982 DOI: 10.1111/ejh.13481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Management of pregnancy in women with congenital bleeding disorders (CBD) is challenging and requires understanding of risks conferred to both the mother and the foetus. Some elements of labour management are considered to increase the risk of neonatal bleeding and are not recommended for neonates at risk of a significant bleeding disorder. The impact of these restrictions on obstetric outcomes in women with CBD is unknown. METHODS We retrospectively reviewed obstetric outcomes in a large cohort of women with CBD attending a specialised obstetric/haematology antenatal clinic over a 6-year period. RESULTS Ninety-four pregnancies in 76 women with a wide variety of CBDs were assessed. Foetal precautions were recommended in the majority of cases (88%). Twenty (21.2%) were delivered by elective Caesarean section (CS), predominantly for obstetric indications. Of the 63 women who laboured with foetal precautions in place, 6 (10%) had a CS that was performed because of these precautions. There was no neonatal bleeding but primary postpartum haemorrhage (PPH) occurred in 12.2% of women. CONCLUSIONS These data show that foetal precautions in labour recommended for women with CBDs will influence mode of delivery in approximately 10% of cases. This is important information for counselling these women about labour and delivery.
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Affiliation(s)
- Michelle Lavin
- Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maebh Horan
- RCSI Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Anna Durand O'Connor
- RCSI Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Dearbhla Doherty
- National Coagulation Centre, St. James' Hospital, Dublin, Ireland
| | - Catherine Manning
- RCSI Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Caoimhe Lynch
- RCSI Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Carmen Regan
- RCSI Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Kevin Ryan
- National Coagulation Centre, St. James' Hospital, Dublin, Ireland
| | - Bridgette Byrne
- RCSI Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
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9
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Majluf‐Cruz K, Anguiano‐Robledo L, Calzada‐Mendoza CC, Hernández‐Juárez J, Moreno‐Hernández M, Domínguez‐Reyes VM, Figueroa‐Torres AG, Gomez‐Rosas P, Arreola‐Diaz R, García‐Lee MT, Ricardo‐Moreno MT, Sosa‐Camas RE, Garcia‐Chavez J, Vela Ojeda J, Isordia‐Salas I, Majluf‐Cruz A. von Willebrand Disease and other hereditary haemostatic factor deficiencies in women with a history of postpartum haemorrhage. Haemophilia 2019; 26:97-105. [DOI: 10.1111/hae.13900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Karim Majluf‐Cruz
- Hemostasia y Aterogénesis Unidad de Investigación Médica en Trombosis IMSS Ciudad de Mexico Mexico
- Laboratorio de Farmacologia Molecular Escuela Superior de Medicina Instituto Politecnico Nacional Ciudad de Mexico Mexico
| | - Liliana Anguiano‐Robledo
- Laboratorio de Farmacologia Molecular Escuela Superior de Medicina Instituto Politecnico Nacional Ciudad de Mexico Mexico
| | - Claudia C. Calzada‐Mendoza
- Seccion de Estudios de Postgrado e Investigación Escuela Superior de Medicina Instituto Politecnico Nacional Ciudad de Mexico Mexico
| | - Jesús Hernández‐Juárez
- Hemostasia y Aterogénesis Unidad de Investigación Médica en Trombosis IMSS Ciudad de Mexico Mexico
- CONACYT‐Facultad de Odontología Universidad Autónoma Benito Juárez de Oaxaca Ciudad Universitaria Oaxaca de Juarez Oaxaca México
| | - Manuel Moreno‐Hernández
- Hemostasia y Aterogénesis Unidad de Investigación Médica en Trombosis IMSS Ciudad de Mexico Mexico
| | | | | | - Patricia Gomez‐Rosas
- Servicio de Hematologia Hospital General Regional Tecamac IMSS Estado de Mexico Mexico
| | - Rodrigo Arreola‐Diaz
- Hemostasia y Aterogénesis Unidad de Investigación Médica en Trombosis IMSS Ciudad de Mexico Mexico
| | - María Teresa García‐Lee
- Servicio de Hematologia Hospital General Regional Carlos McGregor Sanchez Navarro IMSS Ciudad de Mexico Mexico
| | | | - Rosa Elena Sosa‐Camas
- Departamento de Medicina Interna Hospital General de Hermosillo Secretaria de Salud Hermosillo Mexico
| | - Jaime Garcia‐Chavez
- Unidad de Investigación en Enfermedades Hematologicas Hospital de Especialidades CMN La Raza IMSS Ciudad de Mexico Mexico
| | - Jorge Vela Ojeda
- Unidad de Investigación en Enfermedades Hematologicas Hospital de Especialidades CMN La Raza IMSS Ciudad de Mexico Mexico
| | - Irma Isordia‐Salas
- Hemostasia y Aterogénesis Unidad de Investigación Médica en Trombosis IMSS Ciudad de Mexico Mexico
| | - Abraham Majluf‐Cruz
- Hemostasia y Aterogénesis Unidad de Investigación Médica en Trombosis IMSS Ciudad de Mexico Mexico
- Servicio de Hematologia Hospital General Regional Carlos McGregor Sanchez Navarro IMSS Ciudad de Mexico Mexico
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10
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Winikoff R, Scully MF, Robinson KS. Women and inherited bleeding disorders - A review with a focus on key challenges for 2019. Transfus Apher Sci 2019; 58:613-622. [PMID: 31582329 DOI: 10.1016/j.transci.2019.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The area of women and inherited bleeding disorders has undergone quick expansion in recent years. More patients are being identified and expertise to diagnose and manage these patients is now essential for practising physicians. Programs to help educate and empower patients and caregivers are now in place. Common inherited bleeding disorders affecting women include von Willebrand disease (VWD), inherited platelet disorders, and rare inherited bleeding disorders such as factor VII (FVII) deficiency and factor XI (FXI) deficiency. Specific clinical tools have been developed to help clinicians and patients screen for the presence of these bleeding disorders in both adult and pediatric populations. Affected women can experience heavy menstrual bleeding and resulting iron deficiency anemia, postpartum hemorrhage, and hemorrhagic ovarian cysts which need to be properly managed. Excessive bleeding can adversely affect quality of life in these women. Front line therapy for bleeding in mild cases focuses on the use of non-specific hemostatic agents such as DDAVP ®, tranexamic acid and hormonal agents but specific factor replacement and/or blood products may be required in more severe cases, in severe bleeding or as second line treatment when bleeding is not responsive to first line agents. Iron status should be optimised in these women especially in pregnancy and use of an electronic app can now help clinicians achieve this. These patients should ideally be managed by a multidisciplinary team whenever possible even remotely. Although clinical research has closed some knowledge gaps regarding the diagnosis and management of these women, there remains significant variation in practise and lack of evidence-based guidelines still exists in many spheres of clinical care in which caregivers must rely on expert opinion. Ongoing efforts in education and research will continue to improve care for these women and restore quality of life for them.
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Affiliation(s)
- R Winikoff
- Division of Hematology-Oncology, Sainte-Justine University Hospital Center, Montréal, QC, Canada
| | - M F Scully
- Department of Medicine, Memorial University of Newfoundland Medical School, NL, Canada.
| | - K S Robinson
- Division of Hematology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Department of Medicine, Halifax, NS, Canada.
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11
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Parker JW, James PD, Haley SL. Spinal Anesthesia in 2 Consecutive Cesarean Deliveries in a Parturient With Type 3 von Willebrand Disease. A A Pract 2019; 12:79-81. [DOI: 10.1213/xaa.0000000000000854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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12
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The impact of antenatal factor XIII levels on postpartum haemorrhage: a prospective observational study. Arch Gynecol Obstet 2018; 299:421-430. [DOI: 10.1007/s00404-018-4980-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/16/2018] [Indexed: 12/19/2022]
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13
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Moorehead PC, Chan AKC, Lemyre B, Winikoff R, Scott H, Hawes SA, Shroff M, Thomas A, Price VE. A Practical Guide to the Management of the Fetus and Newborn With Hemophilia. Clin Appl Thromb Hemost 2018; 24:29S-41S. [PMID: 30373387 PMCID: PMC6714852 DOI: 10.1177/1076029618807583] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Newborns with hemophilia are at risk of intracranial hemorrhage, extracranial hemorrhage,
and other bleeding complications. The safe delivery of a healthy newborn with hemophilia
is a complex process that can begin even before conception, and continues throughout
pregnancy, birth, and the newborn period. This process involves the expectant parents and
a wide variety of health-care professionals: genetic counselors, obstetricians,
neonatologists, pediatricians, radiologists, adult and pediatric hematologists, and nurses
with expertise in hemophilia. Because of this multidisciplinary complexity, the relative
rarity of births of newborns with hemophilia, and the lack of high-quality evidence to
inform decisions, there is considerable variation in practice in this area. We present a
comprehensive multidisciplinary approach, from preconception counseling to discharge
planning after birth, and describe available options for management decisions. We
highlight a number of areas of important uncertainty and controversy, including the
preferred mode of delivery, the appropriate use and timing of neuroimaging tests, and the
appropriate use of clotting factor concentrates in the newborn period. While the approach
presented here will aid clinicians in planning and providing care, further research is
required to optimize the care of newborns with hemophilia.
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Affiliation(s)
- Paul C Moorehead
- Section of Pediatric Hematology/Oncology, Janeway Children's Health and Rehabilitation Centre, St. John's, Canada.,Discipline of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Canada
| | - Anthony K C Chan
- McMaster Children's Hospital, McMaster University, Hamilton, Canada
| | - Brigitte Lemyre
- Department of Pediatrics, Division of Neonatology, University of Ottawa, Ottawa, Canada
| | - Rochelle Winikoff
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Ste-Justine University Health Center, University of Montreal, Montreal, Canada
| | - Heather Scott
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, Canada
| | - Sue Ann Hawes
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Canada
| | - Manohar Shroff
- Department of Radiology, Hospital for Sick Children, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Aidan Thomas
- Maritime Medical Genetics Service, IWK Health Centre, Halifax, Canada
| | - Victoria E Price
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Canada
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14
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Hermans C, Kulkarni R. Women with bleeding disorders. Haemophilia 2018; 24 Suppl 6:29-36. [DOI: 10.1111/hae.13502] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 12/26/2022]
Affiliation(s)
- C. Hermans
- Haemostasis and Thrombosis Unit; Division of Haematology; Cliniques universitaires Saint-Luc; Brussels Belgium
| | - R. Kulkarni
- Department of Pediatrics and Human Development; Michigan State University; East Lansing MI USA
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15
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Postpartum Hemorrhage in Women with Von Willebrand Disease - A Retrospective Observational Study. PLoS One 2016; 11:e0164683. [PMID: 27780267 PMCID: PMC5079555 DOI: 10.1371/journal.pone.0164683] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 09/29/2016] [Indexed: 11/24/2022] Open
Abstract
Introduction von Willebrand disease (VWD) is a hereditary bleeding disorder, caused by a deficiency in the levels and/or function of von Willebrand factor (VWF). Women with VWD appear to be at increased risk of experiencing postpartum hemorrhage (PPH), though the levels of VWF increase during pregnancy. There is limited knowledge of how PPH is associated with the subtype of VWD, plasma levels of other coagulations factors than VWF and given hemostatic treatment. Aims The aims were to investigate the incidence of PPH in women with VWD and to analyse the correlation between PPH and: (1) type of VWD, (2) laboratory monitoring of VWF and FVIII and (3) hemostatic drug treatment. Methods This was a retrospective observational study. The study participants (n = 34) were recruited from the Coagulation Unit, Karolinska University hospital. Fifty-nine deliveries, which occurred in 14 different obstetrics units (years 1995–2012) were included in the study. Results The incidence of primary PPH was 44%, severe primary PPH 20% and secondary PPH 12%. VWD type 3 was associated with a higher risk of experiencing severe primary PPH compared to other subtypes. FVIII:C in pregnancy was inversely correlated to blood loss during delivery. There was a significantly higher incidence of secondary PPH when the VWD diagnosis was unknown at time of delivery. Conclusions The women with VWD are at higher risk of PPH, especially those with type 3 VWD or when diagnosis is unknown prior to delivery. Identification of pregnant women with undiagnosed VWD may be of importance in order to prevent PPH.
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Lavee O, Kidson-Gerber G. Update on inherited disorders of haemostasis and pregnancy. Obstet Med 2016; 9:64-72. [PMID: 27512496 PMCID: PMC4950409 DOI: 10.1177/1753495x15624307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/30/2015] [Indexed: 12/18/2022] Open
Abstract
Inherited bleeding disorders have the potential to cause bleeding complications during pregnancy, childbirth and the postpartum period as well as effect fetal outcomes. There is an evolving understanding of the need for specialised and individualised care for affected women during these times. The aim for each patient is to estimate the risk to mother, fetus and neonate; to implement measures to minimise these risks; and to anticipate complications and develop contingencies for these scenarios. This includes accurate diagnosis, preconceptual care, prenatal diagnostic options, antenatal care, delivery and postpartum care as well as care of an affected neonate. An understanding of the physiologic haemostatic changes associated with pregnancy as well as the scope of defects, inheritance and management of inherited bleeding disorders is paramount when caring for these women. Collaborative and prospective management in conjunction with haematology services underpins the approach advocated. This review draws on the available literature, and outlines the principles of care for women with inherited bleeding disorders before, during and after pregnancy, as well as their babies, based on both available data and collective clinical experience.
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Affiliation(s)
- Orly Lavee
- Department of Haematology, South Eastern Sydney Local Health District, Prince of Wales Hospital, New South Wales, Australia
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Ho SSY, Barrett A, Thadani H, Asibal CL, Koay ESC, Choolani M. Application of real-time PCR of sex-independent insertion-deletion polymorphisms to determine fetal sex using cell-free fetal DNA from maternal plasma. Clin Chem Lab Med 2016; 53:1189-95. [PMID: 25581758 DOI: 10.1515/cclm-2014-0881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/10/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prenatal diagnosis of sex-linked disorders requires invasive procedures, carrying a risk of miscarriage of up to 1%. Cell-free fetal DNA (cffDNA) present in cell-free DNA (cfDNA) from maternal plasma offers a non-invasive source of fetal genetic material for analysis. Detection of Y-chromosome sequences in cfDNA indicates presence of a male fetus; in the absence of a Y-chromosome signal a female fetus is inferred. We aimed to validate the clinical utility of insertion-deletion polymorphisms (INDELs) to confirm presence of a female fetus using cffDNA. METHODS Quantitative real-time PCR (qPCR) for the Y-chromosome-specific sequence, SRY, was performed on cfDNA from 82 samples at 6-39 gestational weeks. In samples without detectable SRY, qPCRs for eight INDELs were performed on maternal genomic DNA and cfDNA. Detection of paternally inherited fetal alleles in cfDNA negative for SRY confirmed a female fetus. RESULTS Fetal sex was correctly determined in 77/82 (93.9%) cfDNA samples. SRY was detected in all 39 samples from male-bearing pregnancies, and none of the 43 female-bearing pregnancies (sensitivity and specificity of SRY qPCR is therefore 100%; 95% CI 91%-100%). Paternally inherited fetal alleles were detected in 38/43 samples with no SRY signal, confirming the presence of a female fetus (INDEL assay sensitivity is therefore 88.4%; 95% CI 74.1%-95.6%). Since paternally inherited fetal INDELs were not used in women bearing male fetuses, the specificity of INDELs cannot be calculated. Five cfDNA samples were negative for both SRY and INDELS. CONCLUSIONS We have validated a non-invasive prenatal test to confirm fetal sex as early as 6 gestational weeks using cffDNA from maternal plasma.
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[Carriers of haemophilia: Experience of a French university hospital]. ACTA ACUST UNITED AC 2014; 44:565-76. [PMID: 25263159 DOI: 10.1016/j.jgyn.2014.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 07/23/2014] [Accepted: 08/28/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To report the management of carriers of haemophilia in a French university hospital and assess different issues of these patients. PATIENTS AND METHODS Retrospective study of the carriers of haemophilia who consulted at the university hospital of Montpellier, France, between 1995 and 2011. Information were obtained from medical records and from a questionnaire sent to carriers. We recorded data about biological characteristics, bleeding tendency and management of pregnancies. RESULTS Sixty-four carriers of haemophilia A or B were included. Their median FVIII or FIX level was 52 % (range, 15-137 %). Menstrual bleeding lasted more than 7 days in 31 % of carriers. A total of 142 pregnancies started in 54 carriers, and 101 resulted in live births with 26 boys with haemophilia. Sixty-two prenatal diagnoses carried out, 15 have terminated their pregnancy because of a hemophiliac male fetus. Seventy-six percent of deliveries were vaginal delivery and 49 % took place in a level-3 maternity. There were 10.8 % and 8.5 % primary and secondary post-partum hemorrhage, respectively. CONCLUSION The risk of bleeding among carriers of haemophilia is associated with their antihemophilic factor level. To improve the management of carriers, a multidisciplinary and standardized medical record, with a specific questionnaire to evaluate bleedings, could be considered. A regional register that lists all carriers, regardless of their antihemophilic factor level, would also be useful.
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Vaida S, Al-Mondhiry H, Bezinover D, Welsh L, Ural S, Janicki P. Peripartum anesthetic management of a parturient with inherited factor v deficiency. A & A CASE REPORTS 2013; 1:86-88. [PMID: 25612185 DOI: 10.1097/acc.0b013e31829ec0b7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Inherited Factor V deficiency is a rare bleeding disorder. We describe the genetic analysis and anesthetic management of a parturient with severe Factor V deficiency who presented in spontaneous labor. Good hemostatic conditions were obtained with prophylactic fresh frozen plasma administration of 10 mL/kg. Detailed genetic analysis by next-generation sequencing identified several relevant mutations in the coding part of the Factor V (F5) gene in our patient, her parents, and the newborn.
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Affiliation(s)
- Sonia Vaida
- From the Department of Anaesthesiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Schwartz M, Vasudevan A. Current Concepts in the Treatment of Major Obstetric Hemorrhage. CURRENT ANESTHESIOLOGY REPORTS 2013. [DOI: 10.1007/s40140-013-0033-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gestion du péri-partum de la patiente conductrice d’une hémophilie. ACTA ACUST UNITED AC 2013; 32:807-10. [DOI: 10.1016/j.annfar.2013.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 08/22/2013] [Indexed: 11/21/2022]
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Sharief LAT, Kadir RA. Congenital factor XIII deficiency in women: a systematic review of literature. Haemophilia 2013; 19:e349-57. [PMID: 23992439 DOI: 10.1111/hae.12259] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2013] [Indexed: 11/29/2022]
Abstract
Factor XIII (FXIII) deficiency is a rare congenital bleeding disorder. There is a paucity of data in the literature about obstetrics and gynaecological problems in women affected by FXIII deficiency. The aim of this study was to examine gynaecological problems and obstetric complications and outcome in women with congenital FXIII deficiency. An electronic search was performed to identify the published literature on PUBMED, MEDLINE, EMBASE, Journals @OVID and CINAHL Plus databases using the following keywords: 'congenital factor XIII deficiency' AND 'women OR Pregnancy'. A total of 39 relevant articles were found and included in this systematic review; 27 case reports and 12 case series dating from 1964 to 2012. A total of 121 women were identified. Menorrhagia (26%) was the second most common bleeding reported after umbilical bleeding. Ovulation bleeding reported in 8% of women. Among 63 women, 192 pregnancies were reported; of these, 127 (66%) resulted in a miscarriage and 65 (34%) reached viability stage. In 136 pregnancies without prophylactic therapy, 124 (91%) resulted in a miscarriage and 12(9%) progressed to viability stage. Antepartum haemorrhage occurred in 5/65 (8%) pregnancies reaching viability stage while postpartum haemorrhage (PPH) seen in 16 (25%) cases. Women with congenital FXIII deficiency suffer significant bleeding complications. Menorrhagia and ovulation bleeding are common gynaecological problems and more prevalent than reported. Pregnancies in women with FXIII deficiency have a significant risk of miscarriage, placental abruption and PPH if not on prophylaxis treatment.
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Affiliation(s)
- L A T Sharief
- Obstetrics and Gynaecology Department, UCL, London, UK
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Roth P, Bernard JP, Salomon L, Dumez Y, Ville Y. Prélèvements fœtaux : à propos de quelques situations problématiques. ACTA ACUST UNITED AC 2013; 41:446-52. [PMID: 23876417 DOI: 10.1016/j.gyobfe.2013.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 05/29/2013] [Indexed: 10/26/2022]
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Davies J, Kadir RA. Reply to von Willebrand's disease and postpartum haemorrhage by Cheeet al. Haemophilia 2012; 18:e399-400. [DOI: 10.1111/hae.12029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J. Davies
- The Haemophilia Centre and Thrombosis Unit; The Royal Free Hospital; London; UK
| | - R. A. Kadir
- The Haemophilia Centre and Thrombosis Unit; The Royal Free Hospital; London; UK
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