Background: Women with inherited bleeding disorders are at increased risk for bleeding complications during pregnancy and the postpartum period, particularly postpartum haemorrhage (PPH). But bleeding during the preganancy is not well documented.

Aims: This retrospective study evaluates pregnancy management through the Inherited Bleeding Disorders in a tertiary Tunisian maternity, the clinical factors associated with pregnancy-related abnormal bleeding and assesses tranexamic acid use in the postpartum and postabortum prevention of bleeding in these patients.

Methods: It is a retrospective study including 100 pregnancies, from 28 women with inherited bleeding disorders. For each pregnancy, we evaluated patient characteristics (age, haemostatic factor levels) and delivery conditions (term, mode of delivery, postpartum complications and treatment) in relation to abnormal postpartum or postabortum bleeding and/ or thrombosis.

Results: This cohort revealed that 52% of pregnancies terminated at the first trimester with spontaneous abortion with an increased risk of immediate postabortum hemorrage (IPAH)with increased age at the time of abortion (mean age: 33.1 years with IPAH, 28.5 years without IPAH, P = 0.03). The incidence of severe PPH was 24% with an increased risk with birth by vaginal delivery (P = 0.04). Women treated preventively with tranexamic acid postpartum and postabortum had less severe bleeding (P = 0.04) with no thrombotic complications.

Conclusions: Pregnancy is a high risk situation of bleeding in women with inherited bleeding disorders. The first trimester is associated with a high risk of hemorragic abortion that may compromise the future fertility of the patients.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/pregnancy-associated-bleeding-in-women-with-inherited-bleeding-disorders/