Abstract Number: OC 62.4
Meeting: ISTH 2021 Congress
Background: Between 2002-2011, the incidence of severe primary postpartum hemorrhage (PPH) in women with Von Willebrand’s disease (VWD) and hemophilia carriers (HCs) in the Netherlands was 8% (vs. 4.5% in the general population). We hypothesize that PPH has declined over time due to improved management and increased awareness of bleeding disorders.
Aims: To determine the latest incidence of severe primary PPH in women with VWD and HCs in relation to clotting factor activity level and pregnancy management.
Methods: All women with VWD or HCs who delivered between 2012-2017 were selected from all six Dutch Hemophilia Treatment Centers. Patient/disease characteristics, peripartum hematologic/obstetric management and outcomes were retrospectively collected. Severe primary (≥1000 mL blood loss ≤24 hours) and primary (≥500 mL <24hrs) PPH incidence was compared with 1) the previous cohort and 2) the general Dutch population, and between 3) women with third trimester clotting factor activity levels <50 IU/dL vs. ≥50 IU/dL and 4) women treated with vs. without prophylaxis.
Results: 348 deliveries (151 VWD, 167 hemophilia A and 30 hemophilia B carriers) were included. The severe primary PPH incidence was 10% (36/348, Table 1). This risk hasn’t declined over time (prior cohort 8%), but was not higher than seen in the general population (8%, p-value = 0.17). Primary PPH risk was higher in women with coagulation activity levels <50 vs. >50 IU/dL (OR: 2.03, 95% Confidence Interval (CI): 1.16-3.55), despite comparable PPH risk factors. Likewise, women treated with prophylaxis had a higher primary PPH risk than women without (OR: 1.97, 95% CI: 1.18-3.27).
| Deliveries N |
Severe primary PPH N (%) |
Primary PPH N (%) |
||
| Current cohort | Total VWD type 1 VWD type 2 VWD type 3 Hemophilia A carrier Hemophilia B carrier |
348 116 34 1 167 30 |
36 (10) 14 (12) 6 (18) 0 (0) 13 (8) 3 (10) |
99 (28) 36 (31) 17 (50) 1 (100) 34 (20) 11 (37) |
| Factor level in third trimester <50 IU/dL Prophylaxis No prophylaxis ≥50 IU/dL Prophylaxis No prophylaxis |
66 63 3 279 28 251 |
7 (11) 7 (11) 0 (0) 29 (10) 4 (14) 25 (10) |
27 (41) 27 (43) 0 (0) 71 (25) 9 (32) 62 (25) |
|
| Previous Dutch cohort^ | 185 | 14 (8) | 62 (34) | |
| General population* | 743.591 | 57.159 (8) | NA | |
| Legend: VWD = Von Willebrand’s Disease. PPH = postpartum hemorrhage, severe primary and primary PPH being ≥1000 mL and ≥500 mL blood loss within 24 hours, respectively. ^Data derived from Stoof et al. *Data from Perined. NA= Not available. | ||||
Table 1. Postpartum hemorrhage according to bleeding disorder and third trimester factor activity level
Conclusions: Severe primary PPH in women with VWD and HCs did not decline over time and is comparable with the increasing prevalence in the general population. Women with lowest factor levels remain at highest risk for PPH, despite prophylaxis.
To cite this abstract in AMA style:
Punt MC, van Leusden F, Bloemenkamp KWM, Coppens M, Driessens MHE, Haitjema S, Heubel-Moenen FC, Lely AT, Mäkelburg AB, Nieuwenhuizen L, van Solinge WW, Saes JL, Schols SEM, Schutgens REG, Eikenboom J, Kruip MJ, van Galen KPM. Postpartum Hemorrhage in Women with von Willebrand Disease and Carriers of Hemophilia: A Retrospective Analysis [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/postpartum-hemorrhage-in-women-with-von-willebrand-disease-and-carriers-of-hemophilia-a-retrospective-analysis/. Accessed October 1, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/postpartum-hemorrhage-in-women-with-von-willebrand-disease-and-carriers-of-hemophilia-a-retrospective-analysis/