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Pregnancy management for patients with bleeding disorders.
Nidhi Patel1, Bethany Samuelson Bannow2
1Department of Internal Medicine, Providence Portland, Portland, OR.
Hematology. American Society of Hematology. Education Program
|December 5, 2025
Summary
Pregnant individuals with bleeding disorders face higher postpartum hemorrhage risks. Multidisciplinary care and timely factor level monitoring are crucial for managing bleeding during and after pregnancy.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Maternal-Fetal Medicine
Background:
- Pregnant persons with bleeding disorders (pwBD) have increased risks of postpartum hemorrhage (PPH).
- Pregnancy-induced hypercoagulable state may not ensure adequate hemostasis in pwBD with von Willebrand disease, qualitative platelet defects (QPDs), or hemophilia carriers (HC).
- Multidisciplinary care involving hematologists, obstetricians, anesthesiologists, and geneticists is beneficial for pwBD.
Purpose of the Study:
- To outline the risks and management strategies for pregnant persons with bleeding disorders.
- To emphasize the importance of multidisciplinary care and factor level monitoring.
- To discuss hemostatic therapies and delivery considerations for pwBD.
Main Methods:
- Review of current literature and clinical practices for managing bleeding disorders in pregnancy.
- Emphasis on obtaining baseline and antepartum factor levels for delivery planning.
- Discussion of various hemostatic therapies, including antifibrinolytics, desmopressin, factor concentrates, and blood products.
Main Results:
- Target factor levels for delivery remain controversial due to unpredictable phenotype-level correlation.
- Antifibrinolytic agents like tranexamic acid show robust evidence for PPH management.
- Factor concentrates are increasingly used, with blood products as alternatives for QPDs or when concentrates are unavailable.
Conclusions:
- Mode of delivery should prioritize maternal indications, considering risks to both mother and neonate, especially for HCs.
- Postpartum therapies may require continuation for weeks due to the high risk of delayed PPH.
- Proactive, multidisciplinary management is essential for optimizing outcomes in pwBD.
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