Factor deficiency in pregnancy and the role of the delta hemoglobin indices

To evaluate the bleeding degree with objective indices and treatment interventions in the delivery of inherited factor deficiency pregnancies.

The presented case-control study was conducted with pregnancies with factor deficiencies. Maternal obstetrical history, disease characteristics (factor levels, duration of disease, and bleeding history), and treatment features during pregnancy were evaluated. Obstetric (delivery mode, antepartum/postpartum bleedings) and neonatal outcomes (birth weights, birth weeks, APGAR scores) of the study group were compared to those of the control group. The Delta hemoglobin/hematocrit (prepartum - postpartum hemoglobin/hematocrit), and hemoglobin and hematocrit % change [(prepartum - postpartum hemoglobin/hematocrit)/prepartum hemoglobin/hematocrit] indices were used to assess the extent of bleeding during delivery.

None of the patients had an early postpartum hemorrhage. The delta hemoglobin and hematocrit values were increased in the factor deficiency group, with p-values of 0.019 and <0.001. The hemoglobin and hematocrit percentage changes were also found to increase, associated with p-values of <0.001 and 0.010. Three of the patients (16.7%) had postpartum complications. Gestational age at birth, APGAR scores at 1 and 5 minutes were lower in the factor deficiency group with p-values of 0.016, <0.001, and <0.001, respectively. There was one stillbirth. Most patients received peripartum tranexamic acid treatment, with factor derivatives and desmopressin in required cases.

Hemoglobin/hematocrit delta and change rate indices were increased, although none of the patients were recorded as having early peripartum hemorrhage or needing transfusion. New delta bleeding indices are promising for objectively identifying bleeding and regulating treatment in clinical practice. The experience of this clinical study might guide future studies.