Women and inherited bleeding disorders: pregnancy and delivery

The most common inherited bleeding disorders in women are von Willebrand disease (vWD), carriership of hemophilia A and B, and factor XI (FXI) deficiency. Pregnancy and delivery are associated with major concerns and particular risks in women with these disorders. An increased awareness among clinicians of these disorders and their obstetric complications, a multidisciplinary approach to management, close collaboration between obstetricians and hemophilia centers, and the availability of management guidelines are essential to minimize maternal and neonatal complications. The special aspects of obstetric management include prenatal diagnosis, and antenatal, intrapartum, postpartum, and neonatal care. The issue of prenatal diagnosis is primarily considered in carriers of hemophilia because of severity of the disease in their male offspring and knowledge of genetic defects in most of affected families. The uptake of prenatal diagnosis, methods used, and technical aspects of invasive procedures are discussed. Hemostatic response to pregnancy is variable in different types of inherited bleeding disorders. Monitoring of coagulation status and appropriate prophylaxis, when indicated, is essential for safe pregnancy and delivery. Invasive intrapartum monitoring techniques and instrumental deliveries should be avoided. Delivery should be achieved by the least traumatic method to minimize the risk of postpartum hemorrhage and neonatal hemorrhagic complications.